[Closure of traumatic internal carotid-cavernous fistula with an improved type of captive embolus (author's transl)]

A 29-year-old male was treated for a traumatic internal carotid-cavernous fistula by embolization with an improved type of captive polyurethane foam embolus which was inserted through the common carotid artery. Neither the intracranial nor cervical carotid artery was ligated. The angiogram of right carotid taken one month after the surgery revealed satisfactory closure of the fistula and a perfect blood flow from the carotid artery involved. Soon after the operation, the chemosis, exophthalmos and disturbance of the right ocular movements began to diminish. The intracranial noise and bruit disappeared completely. There have been several opinions concerning the best kind of embolizing material and operative procedure. In our case, we devised an improved type of captive mooring embolus. A cylindrical piece of polyurethane foam was used because of its elasticity, plasticity and unabsorbability. To make our embolus we tied one end of a cylindrical embolus with a mooring suture of Nylon mono-filament so that its tip would be small enough to pass easily into the fistula, threaded discoid piece under the other end of the embolus for hook holding action, and fixed a silver clip marker at the tip of the embolus for locating with X-ray. We kept the mooring Nylon thread straignt without curling till operative use. The incised common carotid artery was closed by Iwabuchi's interlacing vascular suture method with excellent results.