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Fujisawa R, Yoshimura Y, Kawano H, Tsuji K, Tsuji A, Nakazawa T, Miyata H, Gomi M, Nozaki K, Yoshida K. Selective Transarterial Embolization for a Ruptured Persistent Trigeminal Artery Variant Aneurysm. NMC Case Rep J 2024; 11:169-174. [PMID: 38974118 PMCID: PMC11224002 DOI: 10.2176/jns-nmc.2024-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/27/2024] [Indexed: 07/09/2024] Open
Abstract
We report a male patient with a ruptured persistent primitive trigeminal artery variant aneurysm that resulted in a fistula with the cavernous sinus. He presented with left conjunctival hyperemia and exophthalmos. Cerebral angiography revealed a left direct carotid-cavernous fistula; however, a balloon occlusion test determined that the source was actually a ruptured aneurysm located on the trunk of a persistent primitive trigeminal artery. Endovascular trapping of the persistent primitive trigeminal artery was performed, which resulted in fistula occlusion and symptom resolution.
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Affiliation(s)
- Ryo Fujisawa
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
- Department of Neurosurgery, Kyoto Okamoto Memorial Hospital, Kuze, Kyoto, Japan
| | - Yayoi Yoshimura
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
- Department of Neurosurgery, Omi Medical Center, Kusatsu, Shiga, Japan
| | - Hiroto Kawano
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Keiichi Tsuji
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
- Department of Neurosurgery, Kyoto City Hospital, Kyoto, Kyoto, Japan
| | - Atsushi Tsuji
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
- Department of Neurosurgery, Omi Medical Center, Kusatsu, Shiga, Japan
| | - Takuya Nakazawa
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
- Department of Neurosurgery, Kyoto Okamoto Memorial Hospital, Kuze, Kyoto, Japan
| | - Haruka Miyata
- Department of Neurosurgery, Kyoto Okamoto Memorial Hospital, Kuze, Kyoto, Japan
| | - Masanori Gomi
- Department of Neurosurgery, Kyoto Okamoto Memorial Hospital, Kuze, Kyoto, Japan
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
- Department of Neurosurgery, National Hospital Organization Higashi-ohmi General Medical Center, Higashi Ohmi, Shiga, Japan
| | - Kazumichi Yoshida
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
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Sun P, Chai Y, Fang W, Chen H, Long Q, Zhao Z, Zhang T. Case report: Spontaneous carotid-cavernous fistula associated with persistent primitive trigeminal artery aneurysm rupture. Front Neurol 2022; 13:923186. [PMID: 36147047 PMCID: PMC9485939 DOI: 10.3389/fneur.2022.923186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/20/2022] [Indexed: 12/03/2022] Open
Abstract
Background The incidence of carotid cavernous fistula (CCF) associated with persistent primitive trigeminal artery (PPTA) aneurysm rupture is extremely rare. We presented a case about a spontaneous CCF secondary to a ruptured PPTA aneurysm, which was successfully embolized with coils and onyx-18 by a trans-arterial approach. Case presentation A 55-year-old female suffered a sudden onset of headache, left orbital pain, and pulsatile exophthalmos for a month without any history of trauma. Angiography revealed a left-sided CCF associated with a ruptured PPTA aneurysm, with major drainage to the ipsilateral superior ophthalmic vein. Through a trans-arterial approach, the fistula and ruptured PPTA aneurysm were embolized with coils and onyx-18, while the cavernous sinus and PPTA were well-preserved. However, the preserved PPTA vanished at 4 month follow-up. The patient had no neurological deficit from hospitalization to 1 year follow-up period. Conclusion Trans-arterial approach was a reasonable choice for spontaneous CCF associated with ruptured PPTA aneurysm. The requirement for PPTA preservation depended on individual evaluation.
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Affiliation(s)
- Peng Sun
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Yuan Chai
- Department of Neurosurgery, Xi'an Central Hospital, Xi'an, China
| | - Wei Fang
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Hu Chen
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Qianfa Long
- Department of Neurosurgery, Xi'an Central Hospital, Xi'an, China
| | - Zhenwei Zhao
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Tao Zhang
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
- *Correspondence: Tao Zhang
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Shiomi K, Yamao Y, Ishii A, Kikuchi T, Okawa M, Yamada K, Yoshida K, Miyamoto S. Carotid-cavernous Fistula Associated with a Ruptured Persistent Primitive Trigeminal Artery Aneurysm: A Case Report and Review of Literature. NMC Case Rep J 2022; 8:691-696. [PMID: 35079535 PMCID: PMC8769437 DOI: 10.2176/nmccrj.cr.2021-0084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/06/2021] [Indexed: 12/02/2022] Open
Abstract
Carotid-cavernous sinus fistula (CCF) caused by a ruptured aneurysm of the persistent primitive trigeminal artery (PPTA) is rarely reported. A 69-year-old woman presented with progressive ptosis and pulsating tinnitus. Vertebral angiography under flow control of the internal carotid artery revealed CCF associated with a ruptured PPTA-trunk aneurysm, and PPTA was divided into Saltzman type 2. Endovascular treatment was performed by coil embolization of the aneurysm and parent artery occlusion of the PPTA, preserving the basilar artery (BA) side of PPTA, without complications. In the case of ruptured aneurysms originating from the Saltzman type 2 PPTA trunk, parent artery occlusion of the PPTA might be a treatment option and preservation of the BA side of PPTA is necessary to avoid ischemic complication of pons.
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Affiliation(s)
- Koji Shiomi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
| | - Yukihiro Yamao
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
| | - Akira Ishii
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
| | - Takayuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
| | - Masakazu Okawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
| | - Kiyofumi Yamada
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
| | - Kazumichi Yoshida
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
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Carotid-Cavernous Sinus Fistula caused by Persistent Primitive Trigeminal Artery Aneurysm rupture: A case report. J Stroke Cerebrovasc Dis 2019; 28:104306. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/26/2019] [Accepted: 07/21/2019] [Indexed: 11/17/2022] Open
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5
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Ishiguro T, Satow T, Okada A, Hamano E, Ikeda G, Chikuie H, Koiso T, Hashimura N, Nishimura M, Takahashi JC. Spontaneous Persistent Primitive Trigeminal Artery−Cavernous Sinus Fistula Successfully Treated by Multipronged Coil Embolization: Case Report and Literature Review. World Neurosurg 2019; 128:122-126. [DOI: 10.1016/j.wneu.2019.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022]
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Diana F, Mangiafico S, Valente V, Wlderk A, Grillea G, Colonnese C, Bartolo M. Persistent trigeminal artery aneurysms: case report and systematic review. J Neurointerv Surg 2019; 11:1261-1265. [DOI: 10.1136/neurintsurg-2019-015046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/30/2019] [Accepted: 06/02/2019] [Indexed: 11/04/2022]
Abstract
BackgroundThe persistent trigeminal artery (PTA) is an adult carotid-basilar anastomosis with debated pathologic aspects, such as its association with brain aneurysms. True trigeminal artery aneurysms are rare vascular anomalies, reported in a few case reports.ObjectiveTo report our experience with a ruptured trigeminal artery aneurysm and to provide a systematic review of the literature in order to analyse potential links between the anatomic configuration of the PTA and PTA aneurysm (PTAA) type, and implications of each PTAA type for the diagnostic and therapeutic approach.MethodsWe reviewed the medical literature on trigeminal artery aneurysms according to the PRISMA guidelines. Population characteristics, aneurysms features, and PTA type and side were assessed.Results40 previously published cases of PTAAs were included in the analysis. The mean age of subjects was 55 years, with a strong female predominance (77%). Four PTAAs were accidentally discovered, while 16 caused compressive symptoms and 20 were ruptured. Successful endovascular treatment was performed in 62% of cases.ConclusionsPTAAs are rare vascular anomalies, underdiagnosed in the presence of a trigemino-cavernous fistula. Parent vessel occlusion seems to be the best therapeutic option for ruptured or symptomatic unruptured PTAAs in Saltzman type II and III PTAs. Patency of the parent vessel is the main target in Saltzman type I PTA.
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Imrie A, Redmond K, Leggett D. Spontaneous direct carotid-cavernous sinus fistula secondary to a persistent primitive trigeminal artery treated by trans-venous coil embolisation. Interv Neuroradiol 2018; 24:567-570. [PMID: 29754515 DOI: 10.1177/1591019918774241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A healthy 51-year-old female presented with a spontaneous direct carotid-cavernous sinus fistula associated with a persistent primitive trigeminal artery. She had no history of connective tissue or cerebrovascular disorders or significant head trauma. This is a rare lesion with only 18 previously reported cases. It had similar clinical presentation and imaging appearance to a high-flow direct carotid-cavernous fistula and was uncovered after successful trans-venous coil embolisation of the fistula. It therefore needs to be considered in cases of direct carotid-cavernous fistula without history of trauma. Knowledge of types of persistent primitive trigeminal artery is also important for their critical treatment implications.
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Affiliation(s)
- Andrew Imrie
- Department of Medical Imaging, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Kendal Redmond
- Department of Medical Imaging, Princess Alexandra Hospital, Woolloongabba, Australia
| | - David Leggett
- Department of Medical Imaging, Princess Alexandra Hospital, Woolloongabba, Australia
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8
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Ruptured Persistent Trigeminal Artery Causing Direct Cavernous Sinus Fistula Treated with Pipeline Embolization and Minimal Coiling. World Neurosurg 2018; 109:471-475.e1. [DOI: 10.1016/j.wneu.2017.10.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 10/02/2017] [Accepted: 10/04/2017] [Indexed: 11/22/2022]
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9
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Vasović L, Jovanović I, Ugrenović S, Vlajković S, Jovanović P, Stojanović V. Trigeminal artery: a review of normal and pathological features. Childs Nerv Syst 2012; 28:33-46. [PMID: 22071960 DOI: 10.1007/s00381-011-1622-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 10/18/2011] [Indexed: 12/28/2022]
Abstract
OBJECTS Carotid-vertebrobasilar anastomoses-the trigeminal, otic, hypoglossal, and proatlantal intersegmental arteries-serve as transitory channels between primitive internal carotid arteries and bilateral longitudinal neural arterial plexus, which is the precursor of future basilar artery, when the human embryo reaches about 4-mm length. MATERIAL AND METHODS Normal and/or abnormal morphofunctional aspects of the prenatal and postnatal forms of the trigeminal artery are described according to personal and literature data. Many arteries of similar origin and course are also noted in the differential diagnosis of the trigeminal artery. CONCLUSIONS The persistent primitive trigeminal artery, as the most commonly carotid-vertebrobasilar anastomosis, has a reported incidence of 0.03-2.2% in the literature. There is female sex predilection, and it may be discovered in patients of any age, on either side, and in association with many vascular variants. Although the significance of persistent primitive trigeminal artery regarding the development of an aneurysm or association with another pathological condition may not be clear, its (ab)normal morphology is the inspiration for anatomists, especially for neurosurgeons, before planning diagnostic and therapeutic procedures.
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Affiliation(s)
- Ljiljana Vasović
- Department of Anatomy, Faculty of Medicine, University of Niš, Blvd. Dr Zoran Đinđić 81, 18000 Niš, Serbia.
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10
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Meckel S, Spittau B, McAuliffe W. The persistent trigeminal artery: development, imaging anatomy, variants, and associated vascular pathologies. Neuroradiology 2011; 55:5-16. [PMID: 22170080 DOI: 10.1007/s00234-011-0995-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Accepted: 11/29/2011] [Indexed: 10/14/2022]
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11
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Yoshida M, Ezura M, Mino M. Carotid-cavernous fistula caused by rupture of persistent primitive trigeminal artery trunk aneurysm--case report. Neurol Med Chir (Tokyo) 2011; 51:507-11. [PMID: 21785245 DOI: 10.2176/nmc.51.507] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 60-year-old female presented with a carotid-cavernous fistula (CCF) manifesting as left abducens nerve palsy. Left internal carotid digital subtraction angiography showed a persistent primitive trigeminal artery (PPTA) near the CCF. Super-selective angiography showed direct shunt flow between the PPTA trunk aneurysm and the left cavernous sinus. The aneurysm was successfully occluded with detachable coils. The CCF disappeared and the PPTA was preserved. The abducens nerve paralysis had disappeared 6 months later. CCF caused by a PPTA trunk aneurysm is extremely rare. We speculate that the PPTA trunk aneurysm formed and then ruptured due to hemodynamic stress caused by hypoplasia of the basilar artery.
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Affiliation(s)
- Masahiro Yoshida
- Department of Neurosurgery, Osaki Citizen Hospital, Osaki, Miyagi, Japan.
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12
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Jin SC, Park H, Kwon DH, Choi CG. Direct carotid cavernous fistula of an adult-type persistent primitive trigeminal artery with multiple vascular variations. J Korean Neurosurg Soc 2011; 49:226-8. [PMID: 21607181 DOI: 10.3340/jkns.2011.49.4.226] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 08/12/2010] [Accepted: 03/27/2011] [Indexed: 11/27/2022] Open
Abstract
We report a case of spontaneous right carotid-cavernous fistula (CCF) in a proximal segment of persistent primitive trigeminal artery (PPTA) and combined vascular anomalies such as left duplicated hypoplastic proximal posterior cerebral arteries and a variation of anterior choroidal artery supplying temporal and occipital lobe. A 45-year-old male presented with progressive right exophthalmos, diplopia, and ocular pain. With manual compression of the internal carotid artery, a cerebral angiography revealed a right CCF from a PPTA. Treatment involved the placement of detachable non-fibered and fibered coils, and use of a hyperglide balloon to protect against coil herniation into the internal carotid artery. A final angiograph revealed complete occlusion of PPTA resulted in no contrast filling of CCF.
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Affiliation(s)
- Sung-Chul Jin
- Cerebrovascular Center, Inje University, Haeundae Paik Hospital, Busan, Korea
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13
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Chen YC, Li MH, Chen SW, Hu DJ, Qiao RH. Incidental Findings of Persistent Primitive Trigeminal Artery on 3-Dimensional Time-of-Flight Magnetic Resonance Angiography at 3.0 T: An Analysis of 25 Cases. J Neuroimaging 2011; 21:152-8. [DOI: 10.1111/j.1552-6569.2010.00472.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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14
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KOBAYASHI N, MIYACHI S, OI S, YAMAMOTO N. Traumatic Carotid-Cavernous Fistula Associated With Persistent Primitive Trigeminal Artery Treated by Transarterial Coil Embolization -Case Report-. Neurol Med Chir (Tokyo) 2011; 51:37-40. [PMID: 21273742 DOI: 10.2176/nmc.51.37] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nozomu KOBAYASHI
- Department of Neurosurgery, Kainan Hospital, Aichi Prefectural Welfare Federation of Agricultural Cooperatives
| | - Shigeru MIYACHI
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
| | - Sachie OI
- Department of Neurosurgery, Chubu-Rosai Hospital
| | - Naohito YAMAMOTO
- Department of Neurosurgery, Kainan Hospital, Aichi Prefectural Welfare Federation of Agricultural Cooperatives
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15
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Kim BM, Kim DI, Kwon TH. Persistent Trigeminal Artery with a Cerebellar Branch and Trigeminal-Cavernous Fistula from Ruptured Aneurysm: Transarterial Coil Embolization. Neurointervention 2010. [DOI: 10.5469/neuroint.2010.5.1.32] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Byung Moon Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ik Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tai Hyung Kwon
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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16
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Liu L, He H, Li Y, Jiang C, Wu Z. Rupture of Persistent Primitive Trigeminal Artery Aneurysm Associated with a Cavernous Sinus Fistula. Neuroradiol J 2009; 22:471-5. [DOI: 10.1177/197140090902200419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Accepted: 07/19/2009] [Indexed: 11/17/2022] Open
Abstract
We describe a patient with an aneurysm arising at a persistent primitive trigeminal artery ruptured to form a carotid-cavernous fistula. Coil occlusion of the carotid cavernous sinus fistula resulted in flow stasis of the persistent primitive trigeminal artery and resolution of symptoms. A ruptured aneurysm of the persistent primitive trigeminal artery can be associated with a carotid cavernous sinus fistula. Coil occlusion of the cavernous sinus and the PPTA is a safe and effective technique to treat this disease.
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Affiliation(s)
- L. Liu
- Beijing Neurosurgical Institute, Beijing, China
| | - H. He
- Beijing Neurosurgical Institute, Beijing, China
| | - Y. Li
- Beijing Neurosurgical Institute, Beijing, China
| | - C. Jiang
- Beijing Neurosurgical Institute, Beijing, China
| | - Z. Wu
- Beijing Neurosurgical Institute, Beijing, China
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17
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Qian CXY, Ares C, Codere F, Tampieri D. Rupture of an aneurysm of the persistent trigeminal artery presenting as a carotid-cavernous sinus fistula. Orbit 2009; 28:275-280. [PMID: 19874119 DOI: 10.3109/01676830903190222] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A 62-year-old Caucasian female presented with spontaneous right-sided eye pain, chemosis and ophthalmoloplegia. A right carotid-cavernous sinus fistula was discovered and successfully treated with transvenous introduction of Guglielmi detachable coils. In addition to complete fistula occlusion, follow-up angiography 6 weeks post-treatment demonstrated the presence of a patent persistent trigeminal artery previously hidden by the caliber of the carotid-cavernous sinus fistula. The spontaneous nature of the presentation and the proximity of the persistent trigeminal artery to the site of coil embolization suggest spontaneous rupture of a persistent trigeminal artery aneurysm as cause of the fistula. Current literature on this finding is discussed here, demonstrating that an aneurysm of the persistent trigeminal artery leading to carotid-cavernous sinus fistula formation is rare. Furthermore, the present case is the first report of its kind in world ophthalmology literature.
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Affiliation(s)
- Cynthia Xin-Ya Qian
- Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada H3T 1J4.
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18
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Geibprasert S, Jiarakongmun P, Krings T, Pongpech S. Trigeminal fistula treated by combined transvenous and transarterial embolisation. Acta Neurochir (Wien) 2008; 150:583-8. [PMID: 18431529 DOI: 10.1007/s00701-008-1496-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2007] [Accepted: 12/12/2007] [Indexed: 10/22/2022]
Abstract
Trigeminal cavernous fistulae are rare, compared to other types of carotid-cavernous fistulae with only about 17 examples previously reported in English literature. The aetiology can be either post-traumatic or spontaneous, and in the latter group either due to a ruptured trigeminal aneurysm or postulated intrinsic weakness of the artery itself. The treatment goal is to close the fistula while preserving the parent artery and this can be done either by surgical or endovascular methods. We present a 35-year-old woman with a spontaneous trigeminal fistula treated by combined trans-venous and trans-arterial embolisation.
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19
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Yao K, Li N. Contralateral Total Steal Associated with Direct High-Flow Shunt Between Carotid Artery and Internal Jugular Vein after Digital Compression of Carotid artery for Posttraumatic Carotid-Cavernous Fistula: A Study of Selective Four-Vessel Angiography Findings. J Craniofac Surg 2005; 16:1130-2. [PMID: 16327569 DOI: 10.1097/01.scs.0000179752.06413.f2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A 40-year-old woman was involved in a traffic accident and was admitted to another hospital with a severe head injury with a Glasgow Coma Scale score 1 of 8. Skull radiographic film showed extensive temoralbasal fracture unilaterally. Two months later, she presented with left ophthalmoplegia and exophthalmos and with chemosis 4 months after the accident.
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Affiliation(s)
- Kunming Yao
- Department of Neurosurgery, Research Division of Cerebrovascular Disease, Zigong 1st People's Hospital, Zigong, Sichuan, China
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20
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Tokunaga K, Sugiu K, Kameda M, Sakai K, Terasaka K, Higashi T, Date I. Persistent primitive trigeminal artery—cavernous sinus fistula with intracerebral hemorrhage: endovascular treatment using detachable coils in a transarterial double-catheter technique. J Neurosurg 2004; 101:697-9. [PMID: 15481730 DOI: 10.3171/jns.2004.101.4.0697] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ Intracerebral hemorrhage occurred in this 61-year-old woman with preexisting diplopia and proptosis. Results of angiography demonstrated a persistent primitive trigeminal artery (PPTA)—cavernous sinus fistula with cortical venous reflux. Two microcatheters were introduced transarterially through the PPTA into the two draining pathways in the cavernous sinus. Coils were delivered in both pathways simultaneously to prevent further venous overload on either path. The fistula was successfully occluded without complication while the PPTA was preserved. The authors describe this double-catheter technique for coil embolization of a fistula and review the literature concerning PPTA—cavernous sinus fistulas.
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Affiliation(s)
- Koji Tokunaga
- Department of Neurological Surgery, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
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21
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Albuquerque FC, Heinz GW, McDougall CG. Reversal of blindness after transvenous embolization of a carotid-cavernous fistula: case report. Neurosurgery 2003; 52:233-6; discussion 236-7. [PMID: 12493124 DOI: 10.1097/00006123-200301000-00031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2002] [Accepted: 05/08/2002] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE Reversal of blindness after the endovascular treatment of a carotid-cavernous fistula (CCF) is exceedingly rare. It has been reported only once in a patient with a direct CCF. We report the first such case in a patient with an indirect CCF. Defining patients whose vision may recover is critical in coordinating the timing of therapy. Mechanisms of reversible visual loss in CCFs are discussed with the intent of elucidating the patients who compose this subgroup. CLINICAL PRESENTATION A 65-year-old man had a 1-week history of blindness, chemosis, and proptosis of the right eye. Ophthalmoscopy was compromised by diffuse choroidal effusion and corneal edema that obscured visualization of the patient's retina. INTERVENTION Transvenous embolization through retrograde catheterization of the superior ophthalmic vein allowed complete coil occlusion of the lesion. The patient's visual loss improved rapidly, returning to normal within 50 days. CONCLUSION Although CCFs frequently are associated with permanent visual loss, a subset of patients demonstrates reversible ocular findings. If the retina of a patient with a CCF seems normal or is obscured, the potential for visual recovery, even from blindness, should prompt emergent treatment.
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Affiliation(s)
- Felipe C Albuquerque
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
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Albuquerque FC, Heinz GW, McDougall CG. Reversal of Blindness after Transvenous Embolization of a Carotid-Cavernous Fistula: Case Report. Neurosurgery 2003. [DOI: 10.1227/00006123-200301000-00031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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