title: Minimally invasive keyhole approach for removal of a migratory balloon complicated by endovascular embolization of a carotid-cavernous fistula.
abstract: OBJECTIVE
  This report presents our experience in using a minimally invasive keyhole approach to remove a migratory balloon in the cerebral artery in one patient.
  
  
  METHODS
  A 19-year-old male suffered from carotid-cavernous fistula after craniofacial trauma two months previously. The patient received endovascular embolization of a carotid-cavernous fistula with detachable balloons. Unfortunately, migration of one balloon to the right middle cerebral artery (MCA) at the M1-M2 junction was noted after detaching the balloon during this procedure. Volume expansion, anticoagulation therapy and an emergency pterional keyhole approach with removal of the displaced balloon were performed successfully. Transient left hemiparesis due to temporary occlusion of the right middle cerebral artery by the balloon was promptly alleviated. There was no definite neurological sequel after the operation.
  
  
  CONCLUSIONS
  Although detachable balloon embolization is the best initial treatment of direct carotid-cavernous fistulas, it is likely to migrate to downstream cerebral arteries. We recommend a minimally invasive pterional keyhole approach as a good alternative for treating such endovascular complications to improve outcome.
authors.affiliation: Department of Neurosurgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
authors.forename: W-Y
authors.initials: WY
authors.lastname: Cheng
authors.forename: S-C
authors.initials: SC
authors.lastname: Chao
authors.forename: W-H
authors.initials: WH
authors.lastname: Chen
authors.forename: C-C
authors.initials: CC
authors.lastname: Shen
mesh_terms: D000328:Adult; D021721:Balloon Occlusion / Q000009:adverse effects*; D020216:Carotid-Cavernous Sinus Fistula / Q000473:pathology / Q000628:therapy*; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D011475:Prosthesis Failure; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome