title: 4D flow preliminary investigation of a direct carotid cavernous fistula due to a ruptured intracavernous aneurysm.
abstract: Inadequate information is available about the cerebral blood flow and surgical strategies of a direct aneurysmal carotid cavernous fistula (daCCF). We report a quantitative analysis of flow velocity and volume using preoperative time-resolved phase-contrast MRI (four-dimensional (4D) flow MRI) in a daCCF. This is the first report of 4D flow findings with a daCCF. A 55-year-old woman developed a sudden headache and bruit of the right orbit, and MRI suggested the presence of a daCCF. Quantitative analysis using preoperative 4D flow MRI revealed the flow volume of the right internal carotid artery. The daCCF was successfully treated by high-flow bypass using a radial artery graft and internal carotid artery trapping. Postoperative angiography showed a complete obliteration of the daCCF. Studies to collect data from additional cases are required so that 4D flow findings can be further used in the management of daCCFs.
authors.affiliation: Department of Neurosurgery, Nippon Medical School, Tokyo, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Nakagawa
authors.affiliation: Department of Neurosurgery, Nippon Medical School, Tokyo, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Murai
authors.affiliation: Department of Neurosurgery, Nippon Medical School, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Wada
authors.affiliation: Department of Neurosurgery, Nippon Medical School, Tokyo, Japan.
authors.forename: Kojiro
authors.initials: K
authors.lastname: Tateyama
mesh_terms: D017542:Aneurysm, Ruptured / Q000150:complications*; D001921:Brain / Q000098:blood supply*; D002343:Carotid Artery, Internal / Q000473:pathology*; D020216:Carotid-Cavernous Sinus Fistula / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D002426:Cavernous Sinus / Q000473:pathology; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation; D004621:Embolization, Therapeutic; D005260:Female; D005402:Fistula; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008875:Middle Aged; D017534:Radial Artery; D058017:Vascular Grafting