Packing Cavernous Sinus: an Alternative Treatment for Traumatic Carotid-Cavernous Fistula

Abstract

Traumatic carotid-cavernous fistula (CCF) is a possible sequelae of head injury. Urgent treatment is always needed to prevent progression and severe complications. Accessibility to neurovascular intervention, the treatment of choice, is quite limited in Thailand because of few neuro-interventionists. The objective of this study was to evaluate the clinical outcomes of surgical treatment which aimed to induce progressive thrombosis of cavernous sinus in traumatic CCF patients. The present study was a retrospective study using medical records of traumatic CCF patients treated with surgical procedures in Ratchaburi hospital from 2010 to 2019. The goal of surgery was selective packing the sinus to induce thrombosis which leading to obliterate the fistula. Both preoperative and postoperative clinical features and imaging studies were observed within two years of the follow-up period. Twelve traumatic CCF patients were surgically treated between 2010 and 2019. Two cases were excluded from the study due to loss to follow-up. One patient had bilateral CCF. All had clinical triad and some suffered from neurological deficits or visual impairment. Selective packing the sinus resulting in immediate closure of the fistula in 4 cases and progressive thrombosis of the sinus leading to occlusion the fistula in 7 cases. External eye signs were recovered mostly within a week after surgery. Neurological deficits reversed in between 3 and 17 weeks. Two patients had remained some visual impairment. Patency of internal carotid artery was demonstrated in all cases. No new deficits or major complications were detected over the follow-up period. In patient with traumatic CCF, surgical treatment by selective packing cavernous sinus is effective and safe which may be considered in the status that endovascular management is inaccessible or failed.