Post-traumatic carotid-cavernous fistula in a pediatric patient: a case-based literature review

• Published in: Child's nervous system 2018-03, Vol.34 (3), p.577-580
• Main Authors: Morais, Barbara Albuquerque, Yamaki, Vitor Nagai, Caldas, Jose Guilherme Mendes Pereira, Paiva, Wellingson Silva, Matushita, Hamilton, Teixeira, Manoel Jacobsen
• Format: Article
• Language: English
• Subjects: Carotid-Cavernous Sinus Fistula - diagnostic imaging; Carotid-Cavernous Sinus Fistula - etiology; Carotid-Cavernous Sinus Fistula - surgery; Case Report; Child; Craniocerebral Trauma - complications; Craniocerebral Trauma - diagnostic imaging; Craniocerebral Trauma - surgery; Endovascular Procedures - methods; Eye Injuries - complications; Eye Injuries - diagnostic imaging; Eye Injuries - surgery; Humans; Male; Medicine; Medicine & Public Health; Neurosciences; Neurosurgery; Wounds, Penetrating - complications; Wounds, Penetrating - diagnostic imaging; Wounds, Penetrating - surgery
• ISSN: 0256-7040; 1433-0350
• DOI: 10.1007/s00381-017-3668-7

Background Carotid-cavernous fistula (CCF) is a shunt between the carotid artery and the cavernous sinus. Traumatic CCFs are diagnosed in 0.2% of head traumas being only 4.6% of the pediatric population. Classified by Barrow in 1985, type A CCF is the most frequent, occurring in 75% of cases. Type A is characterized by direct and high-flow CCF that generally can occur as a result of traumatic injury or rupture of an intracavernous aneurysm. Case presentation The subject was an 8-year-old boy with penetrating trauma to his left eye. During the initial evaluation, a computed tomography (CT) scan was unremarkable, and after relief of symptoms, the patient was discharged. Seven days later, he developed grade I proptosis, conjunctival chemosis, ophthalmoplegia (III, IV, and VI cranial nerve palsies), and left-sided ptosis and mydriasis. Arteriography confirmed a post-traumatic CCF, and the patient was treated with an endovascular detachable balloon. Conclusion CCF should be suspected in craniofacial traumas with ocular symptoms. The presence of a skull base fracture on CT is a poor predictor of CCF associated with head trauma. Early diagnosis and treatment can prevent permanent neurological deficits and unfavorable outcomes.