Usefulness of C-Arm Cone-Beam Computed Tomography in Endovascular Treatment of Traumatic Carotid Cavernous Fistulas: A Technical Case Report

BACKGROUND: Detailed information about the anatomy of traumatic carotid cavernous fistula (CCF) is required for determining the appropriate treatment strategy. OBJECTIVE: We report the usefulness of C-arm cone-beam computed tomography (CBCT) for visualizing traumatic CCF during endovascular treatment. CLINICAL PRESENTATION: A 63-year-old woman presented with right pulsating tinnitus 1 week after a bicycle accident. Right internal carotid angiography demonstrated a right CCF but failed to visualize its precise location because the cavernous portion of the right internal carotid artery (ICA) was hidden by early filling of the cavernous sinus during both conventional digital subtraction angiography (DSA) and 3-dimensional digital angiography. TECHNIQUE: C-arm CBCT, performed with a flat-panel detector mounted in a C-arm angiographic system, clearly depicted the tear in the medial wall of the C4 segment of the right ICA. Transarterial embolization with coils achieved complete occlusion of the CCF, and the patient's symptoms resolved immediately after the procedure. CONCLUSION: C-arm CBCT is useful to visualize the communication between the ICA and cavernous sinus and helps to determine the treatment strategy for traumatic CCFs.