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CC BY 4.0 · Indian Journal of Neurosurgery 2023; 12(03): 253-257
DOI: 10.1055/s-0043-1772158
Case Report

Challenging Management of an Acute Traumatic Carotid-Cavernous Fistula in a 2-Year-Old Child with Literature Review

Frank Solis 
1   Neurological Surgery and Endovascular Neurosurgery, Instituto de Salud del Niño, San Borja, Lima, Peru
,
Luis Macha
2   Neurological Surgery and Endovascular Neurosurgery, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
,
Mauro Toledo
1   Neurological Surgery and Endovascular Neurosurgery, Instituto de Salud del Niño, San Borja, Lima, Peru
,
Ricardo Gálvez
3   Research Unit, Instituto de Salud del Niño, San Borja, Lima, Peru
,
Rosa Ecos
4   Vascular Neurology, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
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Abstract

Traumatic carotid-cavernous fistula (TCCF) is a rare occurrence in the pediatric population. However, the neurological sequelae of TCCF are associated with higher morbidity and mortality in pediatric patients. We report the case of a 2-year-old child with TCCF treated at a public hospital in Peru. The etiology of the injury was due to a fall of approximately 5 meters. The diagnosis was made based on the clinical picture and neuroimaging findings. The initial proposed treatment was performed with the hope of preserving the parent artery; however, due to persistence of the TCCF, embolization of the parent artery with coils and embolizing substance was performed. A literature review of similar cases was performed and identified eight cases in children under 10 years of age. Endovascular management of an acute TCCF is a challenge due to the high morbidity and mortality during the acute phase and can be complicated when other traumatic injuries are present. Maintaining the parent artery is important; however, when this is not possible, trapping the parent artery may provide an alternate option when appropriate collaterals exist.

Keywords

traumatic carotid-cavernous fistula - type A fistulas - embolization

Authors' Contribution

F.S., L.M., and M.T. were involved in data collection, conceptualization, and manuscript drafting. R.G. helped in data review and translation. R.E. contributed to data review, image preparation, technical and manuscript drafting.




Publication History

Article published online:
10 August 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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