A 38-year-old man was admitted for possible embolization of a left carotid cavernous sinus fistula. Two months previously, the patient had been admitted to the hospital after a motorcycle accident. Twenty-four hours later, he was noted to have left proptosis, chemosis, and a third-nerve palsy. An angiogram was performed and showed a carotid cavernous sinus fistula (Fig. 1 A). The patient was re...

Embolization of a carotid cavernous fistula (CCF) by means of a detachable balloon is an established method for treating CCFs while preserving a patent parent internal carotid artery (ICA). However, failure to embolize the CCF may occur on a few occasions, such as when the balloon cannot pass through the fistula into the cavernous sinus by blood flow, or when the inflated balloon in the caverno...

We report a case of a traumatic cavernous fistula supplied by a persistent primitive trigeminal artery. The process of treatment was unique in this case. Fistula was subcompletely occluded by coiling from primitive trigeminal artery. Residual fistula was helped to form thrombosis by compression of the carotid artery with hand in the procedure. Long-term follow-up was satisfactory. Traumatic cav...

Carotid-cavernous fistulas are abnormal communications between the carotid system and the cavernous sinus. Elevated venous pressure produces congestion in the orbit with resultant transudation of fluid and increased intraocular pressure, thereby leading to secondary glaucoma which may result in visual loss. Immediate treatment is hence, warranted in these cases. The planning of endovascular man...

PURPOSE The classic symptoms and signs of carotid cavernous sinus fistula or cavernous sinus dural arteriovenous fistula (AVF) consist of eye redness, exophthalmos, and gaze abnormality. The angiography findings typically consist of arteriovenous shunt at cavernous sinus with ophthalmic venous drainage with or without cortical venous reflux. In rare circumstances, the shunts are localized outsi...

The authors show that percutaneous puncture of balloons within the cavernous sinus is technically feasible and allows further access to the cavernous sinus after balloon detachment. Complete closure of a large carotid cavernous fistula was achieved in the 37-year-old trauma victim they treated using this technique.

Of the 185 carotid and vertebral fistulas treated by the authors over the past 10 years, five developed neurologic deficits after abrupt closure of their fistulas. The earliest case, treated initially by proximal surgical carotid occlusion, presented 32 years later with cerebral steal symptoms from the large, long-standing carotid cavernous fistula. Upon completion of a surgical trapping proced...

A recently developed neck-bridging device (TriSpan; Target Therapeutics/Boston Scientific, Fremont, CA) was used to prevent coil migration into the internal carotid artery during transvenous occlusion of a high-flow, large-tear carotid cavernous fistula.

BACKGROUND AND PURPOSE Aneurysms of the cavernous segment of the internal carotid artery generally exhibit a benign clinical course, with mass effect on cranial nerves. Rupture generally leads to carotid cavernous fistula and, rarely, to subarachnoid hemorrhage. In this study we report results of treatment in 85 patients with 86 cavernous sinus aneurysms. MATERIALS AND METHODS In a 15-year pe...

BACKGROUND AND PURPOSE Endovascular techniques are the methods of choice for the treatment of patients with carotid cavernous fistulas. We report our experience using stent-assisted coil placement for treatment of patients with high-flow fistulas that are associated with severe laceration of the internal carotid artery. METHODS In a retrospective review of an internal endovascular therapy dat...