A Direct Carotid-Cavernous Fistula due to Penetrating Trauma by a Knitting Needle to the Temporal Region

Abstract

Selcuk Gocmen, Murat Kutlay, Cem Atabey, Ali Kıvanc Topuz, Mehmet Nusret Demircan, Murat Velioglu

Traumatic carotid-cavernous fistulas (CCF) usually occur after closed head injuries. In addition, CCFs can also be caused by penetrating injuries with stab or gunshot injuries. We present the case of traumatic CCF that was caused with a knitting needle directly penetrating through the temporal region. A 46-year-old man consulted with a progressive left swollen eye. His head computed tomography (CT) revealed a left temporal lobe contusion and fracture of the left temporal bone. Digital subtraction angiography (DSA) showed a direct high-flow fistula (Type-A lesion). After the balloon occlusion test, which was well tolerated by the patient, the internal carotid artery was occluded by the interventional radiologist. A review of the literature demonstrated that all of the traumatic CCFs occurred due to penetrating stab injuries through the orbita. To our knowledge, such a case has not been previously reported