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Massive exophthalmos after traumatic carotid-cavernous fistula embolization
E Mateos1, C Arruabarrena, C Veiga
1Ramón y Cajal Hospital, Madrid, Spain.
Orbit (Amsterdam, Netherlands)
|July 7, 2007
Summary
A traumatic carotid-cavernous fistula in an 18-year-old led to vision loss. Successful treatment involved embolization and orbital decompression surgery, improving eye pressure and movement.
Area of Science:
- Ophthalmology
- Vascular Surgery
- Neurosurgery
Background:
- Traumatic carotid-cavernous fistulas (CCFs) can cause significant ocular complications.
- Prompt diagnosis and management are crucial for preserving vision.
Observation:
- An 18-year-old presented with a left traumatic CCF after a traffic accident.
- Initial endovascular embolization failed, leading to worsening proptosis, ophthalmoplegia, and central retinal vein obstruction (CRVO).
Findings:
- A second embolization successfully closed the CCF, but ocular symptoms persisted.
- Orbital decompression surgery improved proptosis, chemosis, and intraocular pressure, with partial visual recovery.
- CRVO in young patients may differ etiologically from elderly patients, with local factors being more prevalent.
Implications:
- This case highlights the complex management of traumatic CCFs and associated CRVO.
- Early detection and intervention for CRVO in young individuals are vital to prevent irreversible vision loss.
- Multidisciplinary approaches combining endovascular techniques and surgical decompression may be necessary.
