Ting W, Richard SA, Changwei Z, Chaohua W, Xiaodong X. Concomitant occurrence of clinoid and cavernous segment aneurysms complicated with carotid cavernous fistula: A case report.
Medicine (Baltimore) 2019;
98:e18184. [PMID:
31770272 PMCID:
PMC6890289 DOI:
10.1097/md.0000000000018184]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 10/10/2019] [Accepted: 10/30/2019] [Indexed: 02/05/2023] Open
Abstract
RATIONALE
Dual aneurysms arising from the internal cerotic artery (ICA) is a very rare occurrence. Clinoid segment aneurysms (CSAs) are often seen at the carotid dural rings while cavernous carotid aneurysms (CCAs) are often a direct communication between the ICA and the cavernous sinus (CS). We present a case of complex concomitant occurrence of a CSA and a CCA complicated with delay aneurysmal rupture (DAR) resulting in carotid cavernous fistula (CCF) after our initial treatment of the patient with pipeline embolization devices (PLEDs) PATIENT CONCERNS:: We present a 64-year old female who we admitted at our institution due to one-year history of double vision. Neurological examinations were unremarkable.
DIAGNOSIS
Magnetic resonance imaging (MRI) and computer tomography (CT)-scan revealed dual aneurysms on the ICA. Digital subtracting angiogram (DSA) confirmed a small CSA and a large CCA on the right ICA.
INTERVENTIONS
We treated both aneurysms with PLED and subsequently observed DAR of CCA as a complication.
OUTCOMES
We successfully occluded the fistula with ONYX (ev3, Irvine, CA) via the trans-venous approach.
LESIONS
PLED was the best endovascular treatment option though DAR was inevitable. Although the trans-arterial approach may be the gold standard for the managing of CCF, the complex nature of our case made us opt for trans-venous approach. The trans-venous route is very appropriate for fistulas with complex parent arteries.
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