Brainstem compression caused by bilateral traumatic carotid cavernous fistulas: case report

Area of Science:

• Neurosurgery
• Vascular Neurology
• Interventional Radiology

Background:

• Bilateral traumatic carotid cavernous fistulas (CCFs) are rare vascular abnormalities.
• These fistulas can lead to significant dilation of the cavernous sinus.
• Cavernous sinus dilation can result in serious neurological complications.

Purpose of the Study:

• To report a rare case of brainstem compression.
• To highlight a unique complication of bilateral traumatic CCFs.
• To emphasize the efficacy of endovascular treatment for CCF complications.

Main Methods:

• A 30-year-old male with severe head trauma presented with epistaxis and bilateral CCFs.
• Initial treatment involved particle embolization for epistaxis and partial embolization of the left CCF.
• Recurrent symptoms led to diagnosis of brainstem compression due to cavernous sinus dilation, treated with balloon embolization.

Main Results:

• The patient initially presented with epistaxis and bilateral CCFs post-trauma.
• A delayed complication of brainstem compression occurred due to cavernous sinus dilation from a reperfused CCF.
• Endovascular balloon embolization successfully resolved the brainstem compression and neurological symptoms.

Conclusions:

• Bilateral traumatic CCFs are uncommon, and brainstem impairment is an extremely rare complication.
• Direct brainstem compression by a dilated cavernous sinus secondary to CCF has not been previously reported.
• Prompt endovascular intervention is crucial for managing such rare and severe complications, leading to complete symptom remission.