title: Recurrent Carotid Cavernous Fistula Originating from a Giant Cerebral Aneurysm after Placement of a Covered Stent.
abstract: We report the case of a recurrent carotid cavernous fistula (CCF) originating from a giant cerebral aneurysm (GCA) after placement of a covered stent. A 47-year-old woman presented with sudden onset of severe headache, and left-sided exophthalmos and ptosis. Cerebral angiography revealed a CCF caused by rupture of a GCA in the cavernous segment of the left internal carotid artery. Two covered stents were placed at the neck of the aneurysm. The neurological symptoms improved at first, but were aggravated in the 6 months following the treatment. Contrast agent endoleak was seen in the distal area of the stent. Even though additional treatments were attempted via an endovascular approach, the CCF could not be cured. However, after trapping the aneurysm using coils and performing superficial temporal artery-middle cerebral artery bypass, the neurological symptoms improved. In cases of recurrent CCF originating from a GCA after placement of a covered stent, it is possible to treat the CCF by endovascular trapping and surgical bypass.
authors.affiliation: Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea.
authors.forename: Jung Wook
authors.initials: JW
authors.lastname: Baek
authors.affiliation: Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea.
authors.forename: Sung Tae
authors.identifier: 0000-0002-3737-3850
authors.initials: ST
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea.
authors.forename: Young Seo
authors.initials: YS
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea.
authors.forename: Young-Gyun
authors.initials: YG
authors.lastname: Jeong
authors.affiliation: Department of Diagnostic Radiology, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea.
authors.forename: Hae Woong
authors.initials: HW
authors.lastname: Jeong
authors.affiliation: Department of Diagnostic Radiology, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea.
authors.forename: Jin Wook
authors.initials: JW
authors.lastname: Baek
authors.affiliation: Department of Neurology, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea.
authors.forename: Jung Hwa
authors.initials: JH
authors.lastname: Seo
keywords: Carotid-cavernous sinus fistula; Intracranial aneurysm; Stents