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Atypical course of carotid cavernous sinus fistula in a six-year-old child
I Kanaan1, R Coates, P Lasjaunias
1Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Insights
A rare case of a 6-year-old boy with a traumatic carotid cavernous sinus fistula causing intraventricular tamponade was successfully treated. The Jaeger-Hamby procedure led to complete fistula obliteration and an excellent recovery.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Pediatric Neurology
Background:
- Carotid cavernous sinus fistulas (CCFs) are abnormal connections between the carotid artery and the cavernous sinus.
- Traumatic CCFs, though rare in children, can lead to severe neurological complications.
- Intraventricular tamponade is a life-threatening complication of CCFs, causing rapid neurological deterioration.
Observation:
- A 6-year-old boy presented with a post-traumatic carotid cavernous sinus fistula.
- The fistula complicated with coma-producing intraventricular tamponade, a critical condition.
- The patient underwent urgent surgical intervention.
Findings:
- The surgical treatment involved external ventricular draining, trapping, and muscle embolization using the Jaeger-Hamby procedure.
- Cerebral angiography confirmed complete obliteration of the carotid cavernous sinus fistula post-treatment.
- The child exhibited an excellent clinical recovery and returned to a normal life.
Implications:
- This case highlights the successful management of a rare and severe complication of traumatic CCF in a pediatric patient.
- The Jaeger-Hamby procedure proved effective in achieving complete fistula closure and preventing recurrence.
- Early and aggressive surgical intervention is crucial for favorable outcomes in pediatric patients with complex CCFs and neurological compromise.
Abstract:
A case of post-traumatic carotid cavernous sinus fistula complicated by coma-producing intraventricular tamponade in a 6-year-old boy is reported. Urgent surgical treatment included external ventricular draining, trapping and muscle embolization by the Jaeger-Hamby procedure. Follow-up cerebral angiography showed complete obliteration of the fistula. The child made an excellent recovery and now leads a normal life.