# Echoes of Trauma: DSA-Guided Coil Embolization for Carotid Cavernous Fistula Presenting with Ocular Bruit and Pulsatile Exophthalmos

## TL;DR

A 47-year-old man with a traumatic carotid cavernous fistula was successfully treated using a combined microsurgical and endovascular approach, resolving his symptoms quickly.

## Contribution

A novel combined microsurgical and endovascular treatment approach for traumatic CCFs is presented.

## Key findings

- The combined treatment led to rapid resolution of pulsatile exophthalmos and ocular bruit.
- Early diagnosis and multidisciplinary intervention improved patient outcomes.
- Minimally invasive procedures are increasingly effective in managing traumatic CCFs.

## Abstract

Carotid-Cavernous Fistulas (CCFs) are abnormal arteriovenous connections between the carotid artery and the cavernous sinus, resulting from trauma. This case report presents a 47-year-old male who developed a CCF following a road traffic accident. The patient exhibited symptoms such as pulsatile exophthalmos and an ocular bruit, characteristic of CCFs. Diagnosis was confirmed through Digital Subtraction Angiography (DSA), revealed the origin of the fistula. The patient was treated using a novel combined approach of microsurgery and endovascular intervention, involving ligation of the internal carotid artery and transarterial coil embolization. The treatment resulted in rapid resolution of symptoms, including the pulsatile exophthalmos and ocular bruit. This case highlights the importance of a multidisciplinary approach, blending microsurgical and advanced endovascular techniques, in effectively managing traumatic CCFs. The study underscores the value of early diagnosis and the evolving role of minimally invasive procedures in improving patient outcomes.