IA. Marzuki, J. Abdullah, Mohtar I, A.R. Ariff, Ibrahim L., M. Hamzah, D. Tang.
Neurosurgical Division, Dept. of Ofthalmology,
Dept. of Radiology, Dept. of Otolaryngology, Head and Neck, School of Medical
Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan Malaysia.
We report the variable management of carotico carvernous fistulas (CCF) over the period of 5 years in Universiti Sains Malaysia. 3 young patients, 2 males and 1 females, age 30 years, 18 years and 16 years respectively were managed after all developed right traumatic CCFs.
The first patient was managed initially by nasal packing prior to cerebral angiogram due to profuse nasal bleeding as a complication of his CCF. Despite common carotid ligation, he developed collateras from the posterior cerebral circulation and from the left carotid artery. Patient expired 6 months later when a second attempt at trapping of the CCF failed.
The second case developed CCF which was managed with both internal and external carotid artery ligation and internal carotid artery clipping via an aneurysm clip. Post operative patient’s CCF disappeared and the exopthalmus resolved. Patient at present after a near 1 year followup is good.
The third case with CCF developed traumatic
lamina cribrosa rhinnorhea which was managed with a galea flap craniotomy
and an embolisation procedure has been planned in an interventional center
in South East Asia.
Result: The mortality rate of untreated
CCF is high unless treated early. The first case was treated late due to
late referral and refusal for management. The second case was managed nearly
a year later and patient had visual and cranial nerve abnormalities prior
to surgery. The 3rd case is now being managed with interventional radiological
methods.
Conclusion: CCF in Malaysia should
be managed via interventional radiological methods. At present no center
does successful interventional cerebral radiology.