Abstract
Direct carotid cavernous fistulas (CCF) are generally well managed by simple endovascular
treatment. We report an 8-year-old boy who required subsequent direct puncture of
the cavernous sinus to completely obliterate the residual fistula after both transarterial
and transvenous embolization had been performed. He presented with a mild right frontal
headache, congestion of the right conjunctiva, blurred vision, and photophobia. Cerebral
angiography demonstrated a right direct CCF. The patient underwent transarterial and
transvenous embolization of the cavernous sinus (CS) with Gugliemi detached coils
(GDCs), but a residual shunt persisted. Two days later, another session of embolization
by direct puncture of the CS with GDCs was performed after failure to navigate through
the superior ophthalmic vein which was partially occupied by previously deployed coils.
Immediate control angiography showed complete obliteration of the fistula and the
patient’s symptoms rapidly resolved. This is the first report of a patient with a
CCF who required three combined approaches – transarterial, transvenous, and direct
puncture of the CS – to achieve complete closure of the complexed shunt.
Keywords
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Article info
Publication history
Accepted:
February 22,
2009
Received:
October 5,
2008
Identification
Copyright
© 2009 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
