[Embolization for traumatic carotid cavernous sinus fistula using platinum coil].

We treated a patient with a traumatic carotid-cavernous fistula (CCF) by embolization using a Tracker catheter and platinum coils by transarterial and transvenous approaches. A 65-year-old female sustained an injury in the right frontal region of the head in April, 1989. After 1 month, she was admitted to our hospital due to exophthalmos, congestion of the palpebral conjunctiva, ptosis, and a bruise in the right frontal region of the head. Right carotid angiography showed a CCF between the anterior ascending segment and the horizontal segment that drains into the superior ophthalmic vein, superior petrosal sinus and inferior petrosal sinus. To occlude the fistula, embolization was performed twice using platinum coils. In the first embolization, the cavernous sinus was approached transarterially and transvenously using a Tracker catheter system, and a total of 7 platinum coils were used for the embolization. The bruise disappeared immediately after embolization but recurred 3 days after the operation. Angiography demonstrated re-communication of the CCF. The second embolization was initially performed using a detachable balloon, but the balloon could not be passed through the fistula. Therefore, a Tracker catheter was advanced to the fistula transarterially and embolization was performed using 3 platinum coils. The fistula was occluded. Follow-up angiography after 1 year in August, 1990 showed complete occlusion of the fistula. The detachable balloon system was recently introduced in neurological and radiological departments, as a new surgical method for CCF. At present, this method is the first choice for CCF. However, the detachable balloon system presents some technical problems.(ABSTRACT TRUNCATED AT 250 WORDS)