Traumatic carotid-cavernous fistula associated with frontal, orbital, and zygomatic fractures: Report of two cases

Objective To report two cases of traumatic carotid-cavernous fistula (CCF) secondary to craniofacial trauma, successfully managed with conservative medical treatment instead of endovascular therapy. Methods Two young male patients developed CCF after high-energy facial trauma with orbital involvement. Diagnosis was established by clinical and neuro-ophthalmologic examination associated with imaging studies, and both were treated with monitored arterial hypotension using propranolol, intravenous corticosteroids, and antibiotics, with conservative management of associated fractures. Result Both patients showed rapid regression of periorbital edema, pain, and ophthalmoplegia, with recovery or preservation of visual function, and imaging at follow-up confirmed spontaneous closure of the fistula and restoration of normal anatomy without recurrence. Conclusion In selected traumatic CCF cases, conservative medical management may achieve spontaneous closure with excellent functional outcomes, representing a viable alternative when endovascular treatment is unavailable or contraindicated.