Traumatic indirect carotid-cavernous fistula: Report of two cases

OBJECTIVE AND CLINICAL IMPORTANCE: We present two cases of posttraumatic indirect carotid-cavernous fistulas. Trauma produces the direct type of carotid-cavernous fistula in almost all cases, and recognition that trauma may induce the indirect type has been rarely reported. CLINICAL PRESENTATION: Both patients presented with signs and symptoms of direct carotid-cavernous fistulas, including bruit, proptosis, and chemosis, after trauma to the head. INTERVENTION: The two patients were treated by transarterial embolization, resulting in immediate and permanent occlusion of the fistula. CONCLUSION: Trauma may rarely induce an indirect type of carotid-cavernous fistula. This posttraumatic, indirect carotid-cavernous fistula was, in these two cases, successfully and permanently cured by transarterial embolization because of the large fistulous connection between the branches of the external carotid artery and the cavernous sinus.