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Increased Cerebral Perfusion After Detachable Balloon Embolization of Carotid Cavernous Fistula on Technetium-99m-HMPAO Brain SPECT

Department of Diagnostic Radiology and Nuclear Medicine, The Yonsei University College of Medicine, Seoul, Korea

Correspondence: For correspondence or reprints contact: Jong-Doo Lee, MD, Department of Diagnostic Radiology, Yonsei University College of Medicine, 134 Shinchondong, Seodaemoonku, Seoul, Korea 120-752.

ABSTRACT

Most symptoms and signs associated with a carotid cavernous fistula (CCF) are thought to be related to regurgitation of flow into cortical veins and to venous congestion. Arteriovenous shunting and secondary perfusion insufficiency is regarded as less important in causing symptoms. We describe a 27-yr-old male patient who had improvement of neurologic symptoms and signs after detachable balloon embolization of traumatic CCF. The pre-and postocclusion ^99mTc-HMPAO brain SPECT scan showed improved cerebral blood flow after occlusion. The CCF had shown marked arteriovenous shunting without significant venous congestion on pre-occlusion cerebral angiogram. The postocclusion cerebral angiogram revealed complete occlusion of the CCF with increased blood flow in the ipsilateral middle cerebral artery distribution. These findings suggest that cerebral dysfunction maybe related to perfusion insufficiency from the CCF. Brain SPECT scanning can assess the functional status of cerebral perfusion and may be a useful, noninvasive adjunct to angiography.