Combined transarterial, transvenous, and direct puncture of the cavernous sinus to cure a traumatic carotid cavernous fistula.
Direct carotid cavernous fistulas (CCF) are generally well managed by simple endovascular treatment. We report an 8-year-old boy who required subsequent direct puncture of the cavernous sinus to completely obliterate the residual fistula after both transarterial and transvenous embolization had been performed. He presented with a mild right frontal headache, congestion of the right conjunctiva, blurred vision, and photophobia. Cerebral angiography demonstrated a right direct CCF. The patient underwent transarterial and transvenous embolization of the cavernous sinus (CS) with Gugliemi detached coils (GDCs), but a residual shunt persisted. Two days later, another session of embolization by direct puncture of the CS with GDCs was performed after failure to navigate through the superior ophthalmic vein which was partially occupied by previously deployed coils. Immediate control angiography showed complete obliteration of the fistula and the patient's symptoms rapidly resolved. This is the first report of a patient with a CCF who required three combined approaches - transarterial, transvenous, and direct puncture of the CS - to achieve complete closure of the complexed shunt.
Lin
Chung-Jung
CJ
Department of Medical Imaging, Far Eastern Memorial Hospital, No. 21, Nan-Ya South Road, Sec 2, Pan-Chiao City, 220, Taiwan. bcjlin@gmail.com
Luo
Chao-Bao
CB
Chang
Feng-Chi
FC
Teng
Michael Mu-Huo
MM
Wang
Kao-Lun
KL
Chu
Shu-Hsun
SH
D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D020216:Carotid-Cavernous Sinus Fistula / Q000000981:diagnostic imaging / Q000628:therapy*; D002426:Cavernous Sinus / Q000000981:diagnostic imaging / Q000601:surgery; D002533:Cerebral Angiography / Q000379:methods; D002648:Child; D017023:Coronary Angiography / Q000379:methods; D004621:Embolization, Therapeutic; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D008297:Male; D011677:Punctures / Q000379:methods