title: Low-flow direct carotid-cavernous fistula caused by rupture of an intracavernous carotid aneurysm.
abstract: Direct carotid-cavernous fistulas (CCFs) secondary to a ruptured intracavernous carotid aneurysm (ICCA) are usually high-flow lesions. On very rare occasions, a ruptured ICCA may present as a low-flow CCF, which poses a diagnostic and therapeutic dilemma whether the aneurysm and the observed fistula are causally related. Herein, we describe a rare case in which a ruptured ICCA resulted in a low-flow CCF. We demonstrated our approach to clarify this clinical scenario, and also propose a possible pathomechanism to explain the existence of low-flow direct CCF.
authors.affiliation: Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network; Toronto, Ontario, Canada - Division of Neurosurgery, Department of Surgery, Taipei Cathay General Hospital; Taipei, Taiwan - Timo.Krings@uhn.ca.
authors.forename: I-Chang
authors.initials: IC
authors.lastname: Su
authors.affiliation: Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network; Toronto, Ontario, Canada.
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Cruz
authors.affiliation: Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network; Toronto, Ontario, Canada - Division of Neurosurgery, Toronto Western Hospital, University of Toronto; Ontario, Canada.
authors.forename: Timo
authors.initials: T
authors.lastname: Krings
mesh_terms: D017542:Aneurysm, Ruptured / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D020216:Carotid-Cavernous Sinus Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D002426:Cavernous Sinus / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D008875:Middle Aged; D010690:Phlebography; D016896:Treatment Outcome
keywords: carotid-cavernous sinus fistula; cavernous sinus; ruptured aneurysm