title: Direct carotid cavernous fistula after trigeminal balloon microcompression gangliolysis: case report.
abstract: OBJECTIVE
  Percutaneous gangliolysis procedures may rarely be associated with vascular complications. There are three reported cases of carotid cavernous fistulas occurring after percutaneous microcompressive trigeminal gangliolysis. This is the only reported case of this complication associated with microcompression gangliolysis.
  
  
  METHODS
  A 78-year-old woman was referred to our institution with a history of abrupt onset of left-sided bruit, proptosis, chemosis, and diplopia after a percutaneous retrogasserian microcompression.
  
  
  METHODS
  Cerebral angiography revealed a large left direct carotid cavernous fistula. Attempts at balloon embolization were unsuccessful, and the lesion was ultimately cured by transarterial and transvenous coil embolization.
  
  
  CONCLUSIONS
  Follow-up examination revealed no evidence of bruit or neurological deficit. This report highlights a unique complication of balloon gangliolysis and describes coil embolization of the fistula as the mode of treatment.
authors.affiliation: Division of Neurosurgery, Oregon Health Science University, Portland, USA.
authors.forename: T A
authors.initials: TA
authors.lastname: Kuether
authors.forename: O R
authors.initials: OR
authors.lastname: O'Neill
authors.forename: G M
authors.initials: GM
authors.lastname: Nesbit
authors.forename: S L
authors.initials: SL
authors.lastname: Barnwell
mesh_terms: D000368:Aged; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging* / Q000628:therapy; D020212:Carotid Artery Injuries; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D002404:Catheterization / Q000295:instrumentation*; D002426:Cavernous Sinus / Q000000981:diagnostic imaging / Q000293:injuries*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D011312:Pressure; D012668:Trigeminal Ganglion; D014277:Trigeminal Neuralgia / Q000628:therapy*