title: Diagnosis and management of trigemino-cavernous fistulas: case reports and review of the literature.
abstract: Although usually asymptomatic, a persistent trigeminal artery (PTA) can rarely be associated with a direct fistula to the cavernous sinus (ie, trigemino-cavernous fistula). We present three patients with trigemino-cavernous fistulas; two were subsequently treated using modern endovascular techniques while the third initially declined therapy. We then review the literature of reported cases of this unusual entity. The aberrant anatomy associated with a PTA presents unique challenges to the management of these lesions, and must be well delineated prior to treatment. Finally, conservative management of trigemino-cavernous fistulas, either de novo or recurrent, may be considered if they demonstrate no evidence of cortical venous reflux and patient symptoms are tolerable.
authors.affiliation: Department of Diagnostic Radiology and Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland, USA.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Miller
authors.affiliation: Department of Diagnostic Radiology and Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland, USA.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Jindal
authors.affiliation: Department of Diagnostic Radiology and Neuroradiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Suyash
authors.initials: S
authors.lastname: Mohan
authors.affiliation: Department of Diagnostic Radiology and Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland, USA.
authors.forename: Manuel
authors.initials: M
authors.lastname: Fortes
authors.affiliation: Department of Diagnostic Radiology and Neuroradiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Hurst
authors.affiliation: Department of Diagnostic Radiology and Neuroradiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Pukenas
authors.affiliation: Department of Diagnostic Radiology and Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland, USA.
authors.forename: Dheeraj
authors.initials: D
authors.lastname: Gandhi
mesh_terms: D000328:Adult; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging* / Q000628:therapy*; D001488:Basilar Artery / Q000002:abnormalities*; D002343:Carotid Artery, Internal / Q000002:abnormalities*; D002426:Cavernous Sinus / Q000000981:diagnostic imaging*; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D011859:Radiography
keywords: Embolic; Fistula; Orbit