A case of traumatic carotid-cavernous fistula (CCF) treated with Debrun's detachable balloon was reported. A pseudoaneurysm was detected because of deflation of the iodine-inflated balloon. A 51-year-old woman was struck on the left frontotemporal area on November 21, 1982, and she began to complain of a bruit in the left frontal area about one hour after the injury. Progressive proptosis, pulsatile exophthalmos, conjunctival congestion and retinal hemorrhage of the left eye became apparent two months later. When examined on admission, she had developed left oculomotor, trochlear and abducens nerve palsy. The left carotid angiograms showed a CCF located between the anterior ascending and horizontal segment of the internal carotid artery. She was treated by endoarterial silicone-inflated balloon catheterization, the bruit disappearing immediately after the embolization. A carotid angiogram was repeated after the treatment because the patient complained of recurrence of the bruit. This disclosed a reappearance of the CCF due to migration of the balloon. The second attempt at embolization failed because of severe spasm of the internal carotid artery. Finally, the CCF was occluded with an iodine-inflated balloon under general anesthesia. Shortly after the last treatment, clinical signs and symptoms completely disappeared.
Repeated angiograms demonstrated a pseudoaneurysm probably due to deflation of the iodine-inflated balloon, though no noticeable neurological deficits have been found to date. Some aspects of pseudoaneurysm following the detachable balloon technique for traumatic CCF were briefly discussed.
