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Improved Turnaround Times | Median time to first decision: 12 days

Research ArticleNeurointervention

Endovascular Management of the Traumatic Cerebral Aneurysms Associated with Traumatic Carotid Cavernous Fistulas

Chao-Bao Luo, Michael Mu-Huo Teng, Feng-Chi Chang, Jiing-Feng Lirng and Cheng-Yen Chang
American Journal of Neuroradiology March 2004, 25 (3) 501-505;
Chao-Bao Luo
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Michael Mu-Huo Teng
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Feng-Chi Chang
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Jiing-Feng Lirng
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Cheng-Yen Chang
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    Fig 1.

    Images in a 49-year-old man with a left TCCF and a TCA of the supraclinoid ICA.

    A, Left frontal carotid angiogram shows a TCCF with moderate steal phenomenon. The aneurysm was overlooked because of its small size and masking by a nearby parent artery and its venous drains.

    B, A detachable balloon was placed into the CS with subtotal occlusion of the TCCF. A small TCA about 3 × 2 mm was found at the left supraclinoid ICA (arrow).

    C, Occlusion of the TCA was achieved by the use of a Guglielmi detachable coil (GDC). Because of the progressive, increased residual fistula flow, the residual TCCF was subsequently obliterated by using GDCs and liquid adhesive, with preservation of the ICA.

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    Fig 2.

    Images in a 40-year-old man with a TCCF and a TCA of the left supraclinoid ICA.

    A, Left lateral carotid angiogram reveals a TCCF with complete steal phenomenon and no opacification of the supraclinoid ICA or TCA.

    B, The TCCF was occluded by a detached balloon. A small TCA at the supraclinoid ICA (arrow) was demonstrated and subtotally obliterated with GDCs.

    C, The patient had a recurrent TCCF due to puncture of the detached balloon; this was eventually occluded by using a detachable balloon, GDCs, and liquid adhesive, with preservation of the ICA.

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    Fig 3.

    Images in a 29-year-old man with a left TCCF and a TCA of the supraclinoid ICA.

    A, Endovascular occlusion of the TCCF was attempted 3 weeks after trauma. Right lateral postembolization angiogram shows partial occlusion of right TCCF. There is no evidence of the TCA at the supraclinoid ICA because of its latent period.

    B, Second embolization was performed 2 weeks after the first attempt. A small TCA was initially ignored (arrow) and found after subtotal occlusion of the residual TCCF. However, fatal rupture occurred before an attempt to treat the TCA was made.

  • Fig 4.
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    Fig 4.

    Images in a 19-year-old man with left paraophthalmic aneurysm associated with a TCCF.

    A, Left carotid angiogram reveals a paraophthalmic TCA (arrow) with rupture into a giant CS varix and draining to the superior ophthalmic vein and inferior petrosal sinus.

    B, The TCA was subtotally occluded by using GDCs, which also resulted in complete occlusion of the TCCF.

Tables

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  • Demographic and clinical outcomes in patients with TCAs associated with TCCFs

    Patient/Sex/Age, (y)Clinical Manifestations on Endovascular TreatmentInitial CT FindingsLocation and Size of the TCA of the ICATCA Detection Prior to TCCF OcclusionSteal of TCCFTrauma to Embolization, wkOutcomeFollow-Up, mo
    1/M/49Chemosis, proptosis, diplopiaSubarachnoid hemorrhage, facial bone fractureSupraclinoid, 3 × 2 mmNoModerate8Occlusion of TCCF and TCA with ICA preservation25
    2/M/40Chemosis, proptosis, decreased visual acuityBrain swelling, facial bone fractureSupraclinoid, 3 × 3 mmNoComplete15Occlusion of TCCF and TCA with ICA preservation24
    3/M/29Chemosis, proptosis, decreased visual acuitySubarachnoid and intracerebral hemorrhages, facial bone fractureSupraclinoid, 3 × 3 mmNoModerate3 and 5Subtotal occlusion of TCCF, fatal rupture of the TCA0.25
    4/M/18Chemosis, proptosis, decreased visual acuity, bruitIntracerebral hemorrhageParaophthalmic, 5 × 4 mmYesOcclusion of the supraclinoid ICA13Occlusion of TCA and TCCF12
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American Journal of Neuroradiology: 25 (3)
American Journal of Neuroradiology
Vol. 25, Issue 3
1 Mar 2004
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Cite this article
Chao-Bao Luo, Michael Mu-Huo Teng, Feng-Chi Chang, Jiing-Feng Lirng, Cheng-Yen Chang
Endovascular Management of the Traumatic Cerebral Aneurysms Associated with Traumatic Carotid Cavernous Fistulas
American Journal of Neuroradiology Mar 2004, 25 (3) 501-505;

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Endovascular Management of the Traumatic Cerebral Aneurysms Associated with Traumatic Carotid Cavernous Fistulas
Chao-Bao Luo, Michael Mu-Huo Teng, Feng-Chi Chang, Jiing-Feng Lirng, Cheng-Yen Chang
American Journal of Neuroradiology Mar 2004, 25 (3) 501-505;
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