• Daisuke Wajima, Ichiro Nakagawa, Hun Soo Park, Shohei Yokoyama, Takeshi Wada, Kimihiko Kichikawa, and Hiroyuki Nakase.
• Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan. Electronic address: wajima@naramed-u.ac.jp.
• World Neurosurg. 2017 Feb 1; 98: 871.e23-871.e28.

BackgroundThe goal of the treatment of direct carotid cavernous fistula (CCF) is to occlude the arteriovenous shunt and to preserve the patency of the concerned internal carotid artery. However, for the ipsilateral posttraumatic fragile cerebrum, coil embolization plus parent artery occlusion for the high-flow direct CCF is better for the prevention of hyperperfusion syndrome and intracranial hemorrhage. We experienced such a case and managed it successfully.Case DescriptionA 6-year-old boy had severe head trauma caused by being hit by a car. He was transferred to our department and diagnosed as having left acute subdural hematoma and acute brain swelling. Emergent evacuation of hematoma and external decompression were performed. He was treated for severe brain swelling in the intensive care unit for 2 months. Cranioplasty was performed 3 months after the injury. His right hemiparesis and aphasia persisted, so he was transferred to a rehabilitation hospital. However, 2 years after the head injury, he was referred to our department because of abducens nerve palsy. He was diagnosed as having a symptomatic posttraumatic direct CCF, which was caused by a ruptured left cavernous giant internal carotid artery aneurysm. The direct CCF was treated with coil embolization of the giant aneurysm and parent artery occlusion.ConclusionsCoil embolization of the aneurysm and parent artery occlusion for the posttraumatic direct CCF was a good option to manage the abducens nerve palsy and to prevent postoperative hyperperfusion.Copyright © 2016 Elsevier Inc. All rights reserved.

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