Korean J Cerebrovasc Surg.  2007 Sep;9(3):216-220.

Posttraumatic Carotid-cavernous fistula Combined with Intracavernous False Aneurysm

Affiliations
  • 1Department of Neurosurgery, Yonsei University, Wonju college of medicine. whangkum@yonsei.ac.kr

Abstract

Posttraumatic high-flow communications between the intracavernous internal carotid artery (ICA) and the cavernous sinus may give rise to two different pathological entities. A connection from the intracavernous ICA system can theoretically connect with two different structures; the vein of the plexus (CCF) or the perivascular bare spaces between the veins (pseudoaneurysm). A CCF and a pseudoaneurysm can be present in the same patient. A 24-year-old man was admitted to our hospital due to sudden mental deterioration. Carotid angiography revealed a CCF, which had occurred after a trauma 5 years earlier, associated with left visual disturbance and skull base fractures. The treatment of choice was permanent coil occlusion of the intracavernous ICA at the level of the lesion. The collateral circulation was evaluated before the endovascular treatment using a balloon test occlusion (BTO). During the BTO, adequate collateral circulation was defined as symmetric angiographic filling of both hemispheres. A continuous neurological examination was performed during the procedure. The follow-up angiography showed a persistent aneurysm occlusion. We report our experience of the successful endovascular treatment of combined lesions with a review of the relevant literature.

Keyword

Carotid-cavernous fistula; Pseudoaneurysm; Endovascular; Balloon test occlusion

MeSH Terms

Aneurysm
Aneurysm, False*
Angiography
Carotid Artery, Internal
Cavernous Sinus
Collateral Circulation
Fistula*
Follow-Up Studies
Humans
Neurologic Examination
Skull Base
Veins
Young Adult
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