Direct surgery for posttraumatic carotid-cavernous fistula as a result of an intradural pseudoaneurysm: case report.
OBJECTIVE
Traumatic carotid-cavernous fistula (CCF) is currently treated with interventional neuroradiological embolization procedures. A rare case of posttraumatic CCF that resulted from an intradural pseudoaneurysm is presented. The patient was treated by direct surgery because an embolization procedure was not suitable.


METHODS
A 16-year-old boy developed chemosis in the right eye 17 days after a traffic accident. Angiography revealed a pseudoaneurysm that arose from the site of origin of the posterior communicating artery, drained directly into the cavernous sinus, and formed a high-flow CCF.


METHODS
Direct surgery was performed to repair the arterial laceration at the junction of the internal carotid artery and the posterior communicating artery. A clip was applied along the internal carotid artery. The posterior stump of the damaged posterior communicating artery was also included in the clip. Postoperatively, the CCF and pseudoaneurysm were completely obliterated, and the symptoms were cured.


CONCLUSIONS
Awareness of an unusual intradural origin of a CCF and the possibility of a direct surgical treatment should be kept in mind.
Fu
Yoshihiko
Y
Department of Neurosurgery, Tsukazaki Hospital, Himeji, Japan.
Ohata
Kenji
K
Tsuyuguchi
Naohiro
N
Hara
Mitsuhiro
M
D000293:Adolescent; D017541:Aneurysm, False / Q000150:complications* / Q000000981:diagnostic imaging; D020212:Carotid Artery Injuries / Q000150:complications* / Q000601:surgery; D002343:Carotid Artery, Internal; D020216:Carotid-Cavernous Sinus Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D002533:Cerebral Angiography; D004388:Dura Mater / Q000098:blood supply*; D006801:Humans; D008297:Male; D014057:Tomography, X-Ray Computed