Use of Detachable Balloon Catheters in the Treatment of Carotid-cavernous Fistula

Abstract

A new flexible detachable balloon apparatus has been developed. It consists of three parts; a silicone balloon, a teflon introducing catheter, and stainless steel coaxial catheter. A coaxial catheter with a stainless steel tubular spring is used to afford a higher degree of flexibility for better navigation in the various angulations of the intracranial vasculature. A miter valve is used as a self-sealing system at the base of the balloon. Twelve patients with carotid-cavernous fistulas (CCF) (traumatic: 10 cases, spontaneous: 2 cases) were treated using two types of detachable balloon systems, namely, Debrun's latex balloon and the authors’ newly developed silicone balloon. Good results were obtained in 11 cases, although four patients required occlusion of the carotid artery. The carotid blood flow was preserved in 8 (67%) out of 12 cases. In cases of total steal shown by carotid angiography, the treatment was more difficult and more than one balloon was sometimes necessary to occlude the fistula. The neurological complications were a case of oculomotor palsy and one of visual impairment, both cases recovering within one week. Postoperative angiography revealed carotid stenosis in one case and a venous pouch in two cases. The detachable balloon techniques should be the standard form of treatment for high flow CCF, particularly if traumatic in origin, when adequate experience has been obtained by the radiological-neurosurgical team. © 1984, The Japan Neurosurgical Society. All rights reserved.