Direct carotid-cavernous fistula (CCF) by selective navigation using a microcatheter or microwire is a rare complication, and its timing of treatment has not been elucidated. We report two cases of direct CCFs resulting from injury to the cavernous posterior segment of the internal carotid artery during selective navigation. We did not plan to perform emergent endovascular treatment for these direct CCFs because no symptoms related to direct CCFs developed. Follow-up angiography revealed spontaneous healing of both direct CCFs. Close observation rather than emergent treatment may represent another option for direct CCF by selective navigation during the endovascular procedure.
OskouianRJKellyDFLawsERJr. Vascular injury and transsphenoidal surgery. Front Horm Res.2006; 34: 256–278.
2.
YoonWKKimYWKimSR. Transarterial coil embolization of a carotid-cavernous fistula which occurred during stent angioplasty. Acta Neurochir (Wien). 2009; 151: 849–853; discussion 853–844.
3.
ParkYSJungJYAhnJY. Emergency endovascular stent graft and coil placement for internal carotid artery injury during transsphenoidal surgery. Surg Neurol. 2009; 72: 741–746.
4.
CiricIRaginABaumgartnerC. Complications of transsphenoidal surgery: Results of a national survey, review of the literature, and personal experience. Neurosurgery. 1997; 40: 225–236; discussion 236–227.
5.
TjoumakarisSIJabbourPMRosenwasserRH. Neuroendovascular management of carotid cavernous fistulae. Neurosurg Clin N Am.2009; 20: 447–452.
6.
CastilloMSilversteinMHoffmanJCJr. Spontaneous thrombosis of a direct carotid cavernous sinus fistula: Confirmation by Gd-DTPA-enhanced MR. Am J Neuroradiol. 1989; 10 (Suppl. 5): 75–76.
7.
ChurojanaAChawalaparitOChiewwitP. Spontaneous occlusion of a bilateral post traumatic carotid cavernous fistula. Interv Neuroradiol. 2001; 7: 245–252.
8.
VoigtKSauerMDichgansJ. Spontaneous occlusion of a bilateral caroticocavernous fistula studied by serial angiography. Neuroradiology. 1971; 2: 207–211.
