Rare Recurrence of Traumatic Carotid Cavernous Fistula after Parent Artery Occlusion—Report of Two Cases and Review of Literature

Abstract The authors present two cases of recurrence of traumatic carotid cavernous fistula (CCF) following complete exclusion by parent artery occlusion (PAO). In both cases, the fistula recurred through the development of indirect CCF and reconstitution of the occluded artery through the development of vasa vasorum or simple recanalization of the parent artery. The cavernous venous sac was patent in both cases. The patent cavernous sac along with the inflammatory or angiogenetic factors might have induced dural neovascularization leading to the development of indirect CCF. These factors along with ischemia of the arterial wall secondary to the steal phenomenon due to persistent shunt flow would have triggered the development of vasa vasorum. Thus the cavernous sac embolization may have to be considered in addition to PAO when PAO is planned as a therapeutic option for direct CCF.

[1]  Jing Chen,et al.  A comparison of different transarterial embolization techniques for direct carotid cavernous fistulas: a single center experience in 32 patients. , 2014, Journal of vascular and interventional neurology.

[2]  N. Kocer,et al.  Endovascular treatment of carotid cavernous sinus fistula: A systematic review. , 2013, World journal of radiology.

[3]  Wan-Yuo Guo,et al.  Transarterial detachable coil embolization of direct carotid‐cavernous fistula: Immediate and long‐term outcomes , 2013, Journal of the Chinese Medical Association : JCMA.

[4]  H. Roh,et al.  Hypertrophy of the Vasa Vasorum: Vascular Response to the Hungry Brain , 2012, The neurologist.

[5]  Mahendran Nadarajah,et al.  Treatment of a traumatic carotid–cavernous fistula by the sole use of a flow diverting stent , 2011, Journal of NeuroInterventional Surgery.

[6]  F. Oka,et al.  Development of Indirect Cavernous Dural Arteriovenous Fistula after Trapping for Direct Carotid Cavernous Fistula , 2011, Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences.

[7]  T. Meguro,et al.  Recanalisation of the internal carotid artery via the vasa vasorum after coil occlusion. , 2011, The British journal of radiology.

[8]  F. Bonneville,et al.  Parent artery occlusion is not obsolete in giant aneurysms of the ICA. Experience with very-long-term follow-up , 2011, Neuroradiology.

[9]  C. You,et al.  Traumatic carotid-cavernous fistulas treated with covered stents: experience of 12 cases. , 2010, World neurosurgery.

[10]  Y. Mao,et al.  LOCAL CHRONIC HYPOPERFUSION SECONDARY TO SINUS HIGH PRESSURE SEEMS TO BE MAINLY RESPONSIBLE FOR THE FORMATION OF INTRACRANIAL DURAL ARTERIOVENOUS FISTULA , 2009, Neurosurgery.

[11]  X. Lv,et al.  A complex cavernous sinus dural arteriovenous fistula secondary to covered stent placement for a traumatic carotid artery-cavernous sinus fistula: case report. , 2008, Journal of neurosurgery.

[12]  T. Itakura,et al.  Indirect Carotid Cavernous Fistula Appeared after Balloon Embolization of Direct CCF , 2002, Acta Neurochirurgica.

[13]  Zhongxue Wu,et al.  Treatment of Traumatic Carotid-Cavernous Fistula , 2000, Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences.

[14]  M. Ezura,et al.  Antegrade recanalization of completely embolized internal carotid artery after treatment of a giant intracavernous aneurysm: a case report. , 1999, Surgical neurology.