Direct carotid-cavernous fistulas (CCFs) are high flow lesions that can be challenging to treat. A number of recent reports suggest that flow diversion may be a viable treatment option. We present a case of a post-traumatic CCF successfully treated with flow diversion and provide a review of the literature. Our results suggest that flow diversion is a potentially effective treatment option for CCFs and is most successful when used as an adjunctive therapy.
SerbinenkoFA. Balloon catheterization and occlusion of major cerebral vessels. J Neurosurg1974; 107: 684–705.
2.
DucruetAFAlbuquerqueFCCrowleyRWet al.The evolution of endovascular treatment of carotid cavernous fistulas: A single-center experience. World Neurosurg2013; 80: 538–548.
3.
TieweiQAliAShaoleiGet al.Carotid cavernous fistulas treated by endovascular covered stent grafts with follow-up results. Br J Neurosurg2010; 24: 435–440.
4.
OhlssonMConsoliARodeschG. Endovascular treatment of carotico-cavernous fistulas with acrylic glue: A series of nine cases. Neuroradiology2016; 58: 1181–1188.
5.
BinkAGollerKLuchtenbergMet al.Long-term outcome after coil embolization of cavernous sinus arteriovenous fistulas. AJNR Am J Neuroradiol2010; 31: 1216–1221.
6.
LuoCBTengMMLinCJet al.Transarterial embolization of traumatic carotid-cavernous fistulae by gugliemi detachable coils. A seven-year experience. Interv Neuroradiol2008; 14(Suppl. 2): 5–8.
7.
YoshidaKMelakeMOishiHet al.Transvenous embolization of dural carotid cavernous fistulas: A series of 44 consecutive patients. AJNR Am J Neuroradiol2010; 31: 651–655.
8.
LvXLLiYXLiuAHet al.A complex cavernous sinus dural arteriovenous fistula secondary to covered stent placement for a traumatic carotid artery-cavernous sinus fistula: Case report. J Neurosurg2008; 108: 588–590.
9.
LuoCBTengMMChangFCet al.Transarterial balloon-assisted n-butyl-2-cyanoacrylate embolization of direct carotid cavernous fistulas. AJNR Am J Neuroradiol2006; 27: 1535–1540.
10.
DebrunGMAletichVAShownkeenHet al.Glued catheters during embolisation of brain AVMs with acrylic glue. Interv Neuroradiol1997; 3: 13–19.
11.
ElhammadyMSWolfeSQFarhatHet al.Onyx embolization of carotid-cavernous fistulas. J Neurosurg2010; 112: 589–594.
12.
ChoiBJLeeTHKimCWet al.Endovascular graft-stent placement for treatment of traumatic carotid cavernous fistulas. J Korean Neurosurg Soc2009; 46: 572–576.
13.
WangCXieXYouCet al.Placement of covered stents for the treatment of direct carotid cavernous fistulas. AJNR Am J Neuroradiol2009; 30: 1342–1346.
14.
ArchondakisEPeroGValvassoriLet al.Angiographic follow-up of traumatic carotid cavernous fistulas treated with endovascular stent graft placement. AJNR Am J Neuroradiol2007; 28: 342–347.
15.
HauckEFNatarajanSKLangerDJet al.Retrograde trans-posterior communicating artery snare-assisted rescue of lost access to a foreshortened pipeline embolization device: Complication management. Neurosurgery2010; 67: 495–502.
16.
PatelPDChalouhiNAtallahEet al.Off-label uses of the pipeline embolization device: A review of the literature. Neurosurg Focus2017; 42: E4.
IancuDLumCAhmedMEet al.Flow diversion in the treatment of carotid injury and carotid-cavernous fistula after transsphenoidal surgery. Interv Neuroradiol2015; 21: 346–350.
19.
OgilvyCSMotiei-LangroudiRGhorbaniMet al.Flow diverters as useful adjunct to traditional endovascular techniques in treatment of direct carotid-cavernous fistulas. World Neurosurg2017; 105: 812–817.
20.
NadarajahMPowerMBarryBet al.Treatment of a traumatic carotid-cavernous fistula by the sole use of a flow diverting stent. J Neurointerv Surg2012; 4: e1.
21.
ChanJLoSChanCet al.Transarterial treatment of traumatic carotid cavernous sinus fistula with carotid artery dissection and ruptured pseudoaneurysm using flow diverter and detachable coils. Hong Kong J Radiol2015; 18: 221–226.
22.
PradeepNNottinghamRKamAet al.Treatment of post-traumatic carotid-cavernous fistulas using pipeline embolization device assistance. J Neurointerv Surg2016; 8: e40.
23.
NossekEZumofenDNelsonEet al.Use of pipeline embolization devices for treatment of a direct carotid-cavernous fistula. Acta Neurochir (Wien)2015; 157: 1125–1130.
24.
AmuluruKAl-MuftiFGandhiCDet al.Direct carotid-cavernous fistula: A complication of, and treatment with, flow diversion. Interv Neuroradiol2016; 22: 569–576.
25.
YoonNKAwadAWGeeJMet al.Ruptured persistent trigeminal artery causing direct cavernous sinus fistula treated with pipeline embolization and minimal coiling. World Neurosurg2018; 109: 471–475.