Primary treatment of an indirect carotid cavernous fistula by injection of N-butyl cyanoacrylate in the dural wall of the cavernous sinus.
BACKGROUND
Carotid cavernous fistulae are abnormal communications between the carotid artery system and the cavernous sinus. Endovascular treatment is the treatment of choice, but because of their heterogeneous etiology and anatomy, an appropriate treatment plan must be tailored for each patient.


METHODS
A 77-year-old diabetic woman presented with rapid onset of right eye pain, conjunctivitis, and chemosis. Angiography revealed an indirect CCF located in the posterior wall of the right cavernous sinus. N-Butyl cyanoacrylate was injected directly into the fistula site in the dural wall via a microcatheter, resulting in a cure.


CONCLUSIONS
We describe an unconventional treatment of an indirect CCF from an IPS approach. One type D(2) CCF was treated successfully using only N-butyl cyanoacrylate injected directly at the fistula site. This was achieved by microcatheterization of the fistula in the posterior wall of the right cavernous sinus.
Shaibani
Ali
A
Department of Radiology, Feinberg School of Medicine of Northwestern University, Chicago, IL 60611, USA.
Rohany
Mehdi
M
Parkinson
Richard
R
Hopkins
John K
JK
Batjer
H Hunt
HH
Dabus
Guilherme
G
Izadi
Kamron
K
Russell
Eric J
EJ
D000368:Aged; D020216:Carotid-Cavernous Sinus Fistula / Q000628:therapy*; D002426:Cavernous Sinus; D003487:Cyanoacrylates / Q000008:administration & dosage*; D004621:Embolization, Therapeutic / Q000379:methods*; D004659:Enbucrilate; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D014014:Tissue Adhesives / Q000008:administration & dosage*
D003487:Cyanoacrylates; D014014:Tissue Adhesives; D004659:Enbucrilate