Traumatic bilateral carotid-cavernous sinus fistulas with progressive unilateral enlargement

The authors present a patient with traumatic bilateral carotid-cavernous sinus fistulas associated with fracture of the sella turcica. Repeat angiography ten days after admission revealed that the left fistula had enlarged and was shunting the entire output of the left carotid artery and a portion of the output of the basilar artery. A muscle embolization procedure was sucessfully performed on the left side but was complicated by hemorrhage from the left cavernous sinus prior to closure. Problems associated with the enlargement of carotid-cavernous fistulas are discussed.