Diagnosis and treatment of bilateral traumatic carotid-cavernous sinus fistulae

The authors report the diagnosis and successful treatment of a case of traumatic bilateral carotid-cavernous sinus fistula. Direct tamponade of the fistula with a Fogarty catheter and ligation of all cervical carotid vessels was carried out on the left side following ligation on the right side of the common carotid, the internal carotid extra- and intracranially, and of the external carotid artery. The pre-requisite for this procedure was the development of a functional collateral circulation via the posterior communicating arteries from the basilar system. The 18 months follow-up report and the rare reports in the world literature on the operative techniques and the results of treatment of similar cases are discussed.