Systematic Analysis of the Risk Factors Affecting the Recurrence of Traumatic Carotid-Cavernous Sinus Fistula

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• 作者：Tzu-Chin Lin¹ ; ⁶ ; Shih-Hsuan Mao² ; ⁶ ; Chih-Hao Chen² ; ⁶ ; Yao-Liang Chen⁴ ; ⁶ ; Ho-Fai Wong³ ; ⁶ ; Chee Jen Chang⁵ ; ⁶ ; ⁷ ; Yin-Cheng Huang⁶ ; ⁸ ; ^{ns3068@gmail.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Debrun classification ; Detachable coils ; Endovascular embolization ; Recurrence ; Traumatic carotid-cavernous sinus fistula
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：90
• 期：Complete
• 页码：539-545.e1
• 全文大小：3745 K

文摘

The current therapies for traumatic carotid-cavernous sinus fistula (tCCF) yield a variable rate of recurrence and produce different results. We analyzed factors among traumatic head injury to identify the risk factors in recurrent tCCFs.

Methods

We retrospectively reviewed patients who were diagnosed with tCCFs from January 2004 to December 2014 in a tertiary referral center. The factors that were analyzed included age, sex, associated injury, clinical presentation, interval from injury to interventions, interventions for tCCFs, and pathologic characters of tCCFs under digital subtraction angiography.

Results

A total of 55 patients with 56 tCCFs (1 bilateral tCCF) were included. Thirty-nine patients (40 tCCFs) were treated successfully in single session of a procedure, whereas 16 patients (16 tCCFs) experienced a recurrence of tCCF. In multivariate analysis, we found that the involvement of C2 or C4 segments (Debrun classification) of intracavernous internal carotid artery is an independent risk factor (hazard ratio [HR] 2.95, 95% confidence interval [95% CI] 1.34–6.52; P < 0.01) for the recurrence of tCCFs. Endovascular coil embolization demonstrated superior efficacy in successful interventions of tCCFs compared with detachable balloons (HR 2.63, 95% CI 1.06–6.57; P < 0.05) and other modalities (HR 3.06, 95% CI: 1.27–7.37; P < 0.05).

Conclusions

A detachable coil is a favorable approach in the management of tCCFs when considering the rate of recurrence. In addition, the involvement of C2 or C4 segments (Debrun classification) served as an independent risk factor of the recurrence of tCCFs.