Spontaneous resolution of a trauma induced direct carotid cavernous fistula

Introduction: Direct carotid cavernous fistulas (CCF) are abnormal communications between the internal carotid artery and the cavernous sinus usually resulting from high energy trauma to the face and base of skull. The management of direct CCF relies on endovascular procedures repairing the malformation as healing cannot take place in the high flow system. Case Report: A 16­year­old male presented to our clinic with complaints of a progressively bulging left eye. He had suffered a severe head injury two months back resulting in an extradural hematoma in the left temporoparietal region which was surgically evacuated. Cerebral imaging revealed a fistula between the internal carotid artery (ICA) and cavernous sinus. While awaiting definitive treatment, the patient was advised to compress his left carotid artery manually about 15­20 times a day as per tolerance. After two weeks the patient was prepared for a definitive endovascular procedure; however the CCF had spontaneously thrombosed. Conclusion: Although rare, spontaneous resolution of direct CCF may occur and in such cases there may be a role of conservative management by decreasing the flow through the fistula by carotid massage and temporary occlusion.