Experience of treating traumatic carotid-cavernous fistula with coils and Onyx

Abstract

Objective To discuss the effectiveness and safety of endovascular treating method of coils combined with Onyx on traumatic carotid-cavernous fistula (T-CCF).Methods After confirming the location of traumatic carotid-cavernous fistula as well as draining characteristics,a micro-catheter was sent into the cavernous sinus of lesion side by transarterial approach with a balloon inflated to cover the fistula and protect the ICA.After several coils were deployed adjacent to the fistula,Onyx 18 was injected into cavernous sinus until the complete occlusion of fistula.Results Balloon-assisted embolization of coils combined with Onyx was adopted in totally 12 T-CCF cases of 13 CCF fistula (involving 1 case of bilateral lesion),among which 11 cases of unilateral lesion showed complete occlusion of fistula in immediate angiogram after treatment,and the other case of bilateral lesion underwent two sessions of embolization.All cases preserved the internal carotid artery lumen.The original symptoms of cranial bruit all disappeared and the ocular and orbital symptoms recovered to different levels.No severe complication related to operation occurred,though 1 case experienced a small amount of bleeding in the lateral fissure zone of the same side from routine CT scan after operation.Follow-up found no recurrence in 3 to 20 months.Conclusions Embolization with coils and Onyx is an effective and safe way on treatment of T-CCF. Key words: Traumatic carotid-cavernous fistula; Coils ; Onyx; Embolization