Multiple Unilateral Traumatic Carotid-Cavernous Sphenoid Sinus Fistulas with Associated Massive Epistaxis: A Consequence of Parkour

“A 25-year-old traceur was performing the basic parkour maneuver known as saut de détente, leaping from rooftop to rooftop, when he plunged 3 stories onto a concrete alley.”

A: Postembolization angiography reveals a marked reduction in flow through the carotid-cavernous fistula and a significant increase in redirection of flow to the left anterior circulation. B: Note the coil mass in the posterior cavernous sinus (black arrow) placed during the transvenous embolization.

A: Postembolization angiography reveals a marked reduction in flow through the carotid-cavernous fistula and a significant increase in redirection of flow to the left anterior circulation. B: Note the coil mass in the posterior cavernous sinus (black arrow) placed during the transvenous embolization.

While traceurs may willingly take on the risks of parkour, a style of free running popular in urban settings, emergency department physicians and specialists are the ones called on to remedy unforeseen consequences. So it was in the unique case report out of Virginia “Multiple Unilateral Traumatic Carotid-Cavernous Sphenoid Sinus Fistulas with Associated Massive Epistaxis: A Consequence of Parkour” featured in the spring 2015 issue of The Ochsner Journal.

The authors describe the diagnostic and surgical challenges presented by a rare case of traumatic carotid-cavernous sphenoid sinus fistulas complicated by multiple tears in the internal carotid artery. After a little more than a week in the hospital, the patient acutely developed a massive epistaxis, requiring emergent endovascular intervention. A month later, a total of 87 detachable coils had been placed via transarterial and transvenous routes in his cavernous and sphenoid sinuses, obliterating multiple fistulas. On hospital day 43, the patient was discharged to an inpatient rehabilitation facility, and 4 months after his initial injury, a repeat cerebral angiogram demonstrated complete resolution of the fistulas.

The mortality rate for patients with carotid-cavernous fistulas who suffer massive epistaxis can be as high as 50%, according to sources cited in the report. Consequently, the authors discuss options for fistula repair ranging from detachable coils and ethylene-vinyl alcohol copolymer (Onyx) to balloons and covered stents.

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