Treatment of carotid-cavernous fistulas with detachable balloon catheter occlusion

Intravascular occlusion of traumatic carotid cavernous fistulas, originally performed under direct visualization with fascia and/or muscle, has evolved into the use of catheters with pressure-sensitive detachable balloons that can be deflated and repositioned prior to final inflation and separation from the catheter. The balloon is filled with contrast material and can be identified with follow-up x-rays. Proptosis is often relieved immediately after this treatment. Detailed pre- and posttreatment ophthalmic evaluations of three consecutive patients with carotid-cavernous fistulas successfully treated with detachable balloon occlusion with a minimum 1-year follow-up are presented. Indications and timing of treatment are discussed. Following blunt head trauma, these patients presented with proptosis, decreased vision, orbital bruit, conjunctival chemosis, diplopia, orbital pain, ocular pulsations and diplopia; they often complained of "a ringing" in the ear on the involved side.