AUTHOR=Loggini Andrea , Kass-Hout Tareq , Awad Issam A. , El Ammar Faten , Kramer Christopher L. , Goldenberg Fernando D. , Lazaridis Christos , Mansour Ali TITLE=Case Report: Management of Traumatic Carotid-Cavernous Fistulas in the Acute Setting of Penetrating Brain Injury JOURNAL=Frontiers in Neurology VOLUME=12 YEAR=2022 URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.715955 DOI=10.3389/fneur.2021.715955 ISSN=1664-2295 ABSTRACT=

Traumatic carotid-cavernous fistulas (tCCFs) after penetrating brain injury (PBI) have been uncommonly described in the literature with little guidance on optimal treatment. In this case series, we present two patients with PBI secondary to gunshot wounds to the head who acutely developed tCCFs, and we review the lead-up to diagnosis in addition to the treatment of this condition. We highlight the importance of early cerebrovascular imaging as the clinical manifestations may be limited by poor neurological status and possibly concomitant injury. Definitive treatment should be attempted as soon as possible with embolization of the fistula, flow diversion via stenting of the fistula site, and, finally, vessel sacrifice as possible therapeutic options.