Rupture of an aneurysm of the persistent trigeminal artery presenting as a carotid-cavernous sinus fistula.
A 62-year-old Caucasian female presented with spontaneous right-sided eye pain, chemosis and ophthalmoloplegia. A right carotid-cavernous sinus fistula was discovered and successfully treated with transvenous introduction of Guglielmi detachable coils. In addition to complete fistula occlusion, follow-up angiography 6 weeks post-treatment demonstrated the presence of a patent persistent trigeminal artery previously hidden by the caliber of the carotid-cavernous sinus fistula. The spontaneous nature of the presentation and the proximity of the persistent trigeminal artery to the site of coil embolization suggest spontaneous rupture of a persistent trigeminal artery aneurysm as cause of the fistula. Current literature on this finding is discussed here, demonstrating that an aneurysm of the persistent trigeminal artery leading to carotid-cavernous sinus fistula formation is rare. Furthermore, the present case is the first report of its kind in world ophthalmology literature.
Qian
Cynthia Xin-Ya
CX
Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada H3T 1J4. xin-ya.qian@umontreal.ca
Ares
Chantal
C
Codere
François
F
Tampieri
Donatella
D
D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging* / Q000628:therapy*; D000792:Angiography; D001488:Basilar Artery; D002343:Carotid Artery, Internal; D020216:Carotid-Cavernous Sinus Fistula / Q000532:radiotherapy* / Q000628:therapy*; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008875:Middle Aged