Post-traumatic carotid-cavernous fistula in a pediatric patient: a case-based literature review

Childs Nerv Syst. 2018 Mar;34(3):577-580. doi: 10.1007/s00381-017-3668-7. Epub 2017 Nov 23.


Background: Carotid-cavernous fistula (CCF) is a shunt between the carotid artery and the cavernous sinus. Traumatic CCFs are diagnosed in 0.2% of head traumas being only 4.6% of the pediatric population. Classified by Barrow in 1985, type A CCF is the most frequent, occurring in 75% of cases. Type A is characterized by direct and high-flow CCF that generally can occur as a result of traumatic injury or rupture of an intracavernous aneurysm.

Case presentation: The subject was an 8-year-old boy with penetrating trauma to his left eye. During the initial evaluation, a computed tomography (CT) scan was unremarkable, and after relief of symptoms, the patient was discharged. Seven days later, he developed grade I proptosis, conjunctival chemosis, ophthalmoplegia (III, IV, and VI cranial nerve palsies), and left-sided ptosis and mydriasis. Arteriography confirmed a post-traumatic CCF, and the patient was treated with an endovascular detachable balloon.

Conclusion: CCF should be suspected in craniofacial traumas with ocular symptoms. The presence of a skull base fracture on CT is a poor predictor of CCF associated with head trauma. Early diagnosis and treatment can prevent permanent neurological deficits and unfavorable outcomes.

Keywords: Carotid-cavernous sinus fistulas; Children; Embolization; Skull base fracture; Traumatic brain injury.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Carotid-Cavernous Sinus Fistula / diagnostic imaging
  • Carotid-Cavernous Sinus Fistula / etiology
  • Carotid-Cavernous Sinus Fistula / surgery*
  • Child
  • Craniocerebral Trauma / complications
  • Craniocerebral Trauma / diagnostic imaging
  • Craniocerebral Trauma / surgery*
  • Endovascular Procedures / methods
  • Eye Injuries / complications
  • Eye Injuries / diagnostic imaging
  • Eye Injuries / surgery*
  • Humans
  • Male
  • Wounds, Penetrating / complications
  • Wounds, Penetrating / diagnostic imaging
  • Wounds, Penetrating / surgery*