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Case Reports: Novel treatment (new drug/interventions; established drug/procedure in new situation)
Successful closure of trigemino-cavernous fistula with minimally invasive approach
  1. Arpan Dutta1,
  2. Subhadeep Gupta1,
  3. Deep Das2,3 and
  4. Rahul Kumar4
  1. 1Department of Neurology, Bangur Institute of Neurology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
  2. 2Department of Neurology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
  3. 3Department of Neurology, Calcutta Medical Research Institute, Kolkata, West Bengal, India
  4. 4Department of Neurology, G S Neuroscience Clinic and Research Center, Patna, Bihar, India
  1. Correspondence to Dr Deep Das; deepdas1974{at}gmail.com

Abstract

A male in his early teens presented with redness of the right eye following a fall. This redness was progressive and increased suddenly over the week prior to presentation. Fundus evaluation revealed an exudative retinal detachment, and a bruit was audible over the right eye. A digital subtraction angiogram revealed the cause to be a ruptured persistent trigeminal artery aneurysm causing a carotid-cavernous fistula like haemodynamic situation with a massively dilated superior ophthalmic vein. Curative embolisation was done using both vertebrobasilar and carotid approach, and the aneurysm as well as the fistula was occluded using detachable coils and n-butyl cyanoacrylate glue. Patient made a complete recovery in his proptosis and chemosis over 8 weeks, with significant improvement of his visual acuity. The key to successful outcome in this case was a complete occlusion with thrombosis of the fistula bed that can only be achieved using a combination of coils and liquid embolic agents.

  • neurological injury
  • neuroimaging
  • neuroopthalmology
  • interventional radiology

https://doi.org/10.1136/bcr-2021-247344

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    Footnotes

    • Contributors RK has treated the patient and has provided all clinical materials. DD has performed secretarial job and research. AD has performed research job and write up. SG has performed secretarial job and research.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.