Abstract
A case of bilateral traumatic carotid-cavernous fistulas (CCFs) is reported. A 39-year-old man had fractures in the skull base and facial bones from a traffic accident. Several days later he had a pulsating proptosis, chemosis, and bruit in both eyes. Neurological examination on admission revealed right-sided blindness due to optic nerve injury. Cerebral angiograms demonstrated bilateral traumatic CCFs with large openings, and steal phenomenon of blood flow. Endarterial balloon catheterization with iodine contrast material was performed twice on the right side and once on the left side but failed. Subsequently the patient suffered from right retro-orbital pain and left blurred vision. A big venous pouch (or false aneurysm) occurred in the cavernous portion of the right carotid artery. The left CCF remained open with venous drainage to the cavernous sinus and superior ophthalmic vein, which resulted in left retinal congestive bleeding. The right venous pouch was treated by occlusion of the internal carotid artery with detachable balloons and external carotid artery to middle cerebral artery bypass with venous graft. The left CCF was treated again by detachable balloon with preservation of the internal carotid artery flow. Postoperative digital subtraction angiography revealed disappearance of bilateral CCFs. Problems of detachable balloon catheterization are discussed.
