Coils and Onyx Embolization of Traumatic Carotid-Cavernous Fistula Caused by an Intradural Internal Carotid Artery Pseudoaneurysm

Abstract

A rare case of traumatic carotid-cavernous fistula caused by an intradural internal carotid artery pseudoaneurysm arising from the intradural internal carotid artery is described. The presentation was similar to that of carotid-cavernous fistulae, with ocular pain, chemosis and proptosis being the common symptoms. The patient was successfully treated by transarterial coil and Onyx-34 embolization. A 40-year-old man presented with severe injury, including multiple fractures of ribs, clavicle scapula and blind left eye. He gradually recovered and was discharged after intensive treatment in a local hospital. But about 70 days after discharge, his left eye became gradually chemotic and he felt a pulsatile bruit in his left ear. A CT scan and DSA confirmed a large intradural pseudoaneurysm and the associated carotid-cavernous fistula. Angiography revealed a fistula between the intradural aneurysm and the cavernous sinus. The origin of the aneurysm was above the posterior communicating artery. The aneurysm was successfully obliterated with detachable coils and Onyx-34 with the protection of a Hyperglide balloon. Subsequent studies demonstrated no flow through the fistula and good opacification of the ipsilateral internal cerebral artery system. Intradural pseudoaneurysm associated with carotid-cavernous fistula is a rare sequel of trauma. It may be treated successfully with the use of transarterial coil and Onyx embolization.