| Section oneEndovascular embolization for the treatment of traumatic carotid cavernous fistula and the following up results after the procedureObjective To investigate and conclude the clinical representation, imaging findings and the therapeutic methods of endovascular embolization for the treatment of TCCF in various location and clinical types. To summarize the clinical representation, technique, complications and treating methods of endovascular embolization for the treatment of TCCF in various location and clinical types, and apply to clicic, meanwhile establish our characteristic cases group of TCCF. To observe the short-term and the long-term effectiveness after endovascular embolization for the treatment of TCCF, and to handle recovery outcome of patients clinical symptom, whether or not recurrence in clinical symptoms. The results of the study could direct the treatment and determine the prognosis for endovascular embolization of TCCF.Methods 119 patients with TCCF were analyzed retrospectively from December 1986 to December 2003.119 cases of TCCF, male 81 cases, female 38 cases, age from 4 to 67 years old, average 30.9. All patients with TCCFconfirmed by cerebral angiography with Seldinger technique adopted in the puncture of femoral artery under heparinization and neuro-sonacon anaesthesia. When the sites, character, size of the fistula, clinical classification and cerebral circulation condition were confirmed and diagnosed, Magic 3 F-1.8 F BDTE catheters combining with balloon were used to embolize the fistula or the internal carotid artery with co-axial detachable balloon catheter(Balt company, France). Detachable coils, Polyvinyl Alcohol(PVA) and NBCA were used necessary. All patients were punctured by the femoral artery-ICA route, the femoral venous-IJV approache and the superior ophthalmic vein route. Follow-up study was taken among 119 patients with TCCF by readmission, part calls and letters to the patients in clinical questionnaires. During readmission, the patients were repeated angiography, CT and MRA. All the data were statisted with SPSS10.0 statistical software package.Results 119 cases of TCCF, the right TCCF in 63 cases, the left in 54 cases and bilateral in 2 cases. Clinical type: type A in 112 cases, type C in 2 cases and type D in 5 cases. The fistulas were located at the junctions of C4 in 81 cases, C5 in 19, C3 in 17 and C2 in 1. The number of fistula was one in 113 cases, two in 6 cases. The character of fistula was small fistula in 8 cases, unusual or special TCCF in 4 cases, wide-necked fistula in 1 case. 128 procedures for embolizations were done. TCCFs were embolized success-fully at the first time. 8 cases failed because of leaking balloons, and the 8 cases were embolized successful in second attempt. The total success rate was 100%. The rate of internal carotid artery patency was 90.8%(108/119). 112 patients were punctured by femoral artery route, 5 patients by femoral vein route, and 2 patient by the superior ophthalmic vein. For the embolization materials, balloons were used in 101 cases, microcoils used in 13 cases, both materials used in 2 cases, and caul- cerebral dura mater used in 3 cass. There was no perioperative mortality or complication after the procedure. 119 patients with TCCF were followed up after endovascular embolization from 3 months to 14 years. 119 clinical questionnaires weremailed and 46 were answered. The following up cases by call were 64. The total getting patients of following up were 110, missing 9 cases. The rate of following up was 92.4%.17 of 110 had repeated MRA and 13 repeated CT, 6 cases had repeated angiography in six months, no anything finding.Conclusion Generally speaking, the TCCF can be successfully treated by balloons embolization via femoral artery-ICA route. For small fistula, microcoils embolization are better. Embolization can be done by venous approach when the internal carotid artery was ligation without deliberately occluding internal carotid artery. Right choices of the approach and the embolization materials are...
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