Traumatic carotid-cavernous fistula identified by three-dimensional digital subtraction angiography--technical note

Area of Science:

• Neuroradiology
• Interventional Neurology
• Vascular Imaging

Background:

• Carotid-cavernous fistulas (CCFs) are abnormal connections between the carotid artery and the cavernous sinus.
• Conventional digital subtraction angiography (DSA) is used for CCF diagnosis but can have limitations in visualizing complex anatomy.
• Accurate anatomical assessment is crucial for effective treatment planning and embolization of CCFs.

Observation:

• Three-dimensional DSA (3D-DSA) provided superior visualization of the CCF's anatomical relationship compared to conventional DSA.
• Endoscopic imaging confirmed the fistula and cavernous sinus, detailing the fistula's direction and location.
• Fistula size assessment using endoscopic images was unreliable due to variations with window threshold adjustments, hindering precise balloon selection.

Findings:

• 3D-DSA significantly improved the understanding of the parent artery and venous anatomy involved in the CCF.
• Despite limitations in size estimation from endoscopic views, 3D-DSA guided the successful catheterization and embolization procedure.
• Embolization of the cavernous sinus was achieved using a detachable balloon via the femoral artery, referencing the 3D-DSA data.

Implications:

• 3D-DSA enhances the pre-procedural evaluation of complex CCFs, offering better anatomical insights than conventional DSA.
• This advanced imaging modality can improve treatment planning and potentially guide the selection of embolic materials.
• Successful embolization underscores the clinical utility of 3D-DSA in managing CCFs, potentially leading to improved patient outcomes.