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CASE REPORT
Combined surgical and endovascular approach to treat a carotid cavernous fistula with associated brainstem venous congestion
  1. Sandeep Muram1,
  2. Javed Khader Eliyas2,
  3. Muneer Eesa3,
  4. Alim P Mitha4
  1. 1Department of Clinical Neurosciences, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
  2. 2Department of Clinical Neurosciences, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
  3. 3Department of Diagnostic Imaging, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
  4. 4Department of Clinical Neurosciences, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
  1. Correspondence to Dr Sandeep Muram, p47sm{at}mun.ca

Summary

Endovascular embolization is the standard approach for management of carotid cavernous fistulas (CCFs) due to the ease of access and reduced level of risk associated with the procedure compared with open surgery. We present here a case of a CCF that eventually led to the development of brainstem venous congestion from perimedullary venous drainage. This fistula was not amenable to endovascular embolization due to lack of either ophthalmic vein or petrosal sinus drainage. Therefore, a craniotomy with direct puncture of the cavernous sinus was performed, followed by coil embolization to completely treat this fistula. This case demonstrates an uncommon progression of venous drainage to Cognard grade V, rare development of symptomatic brainstem venous congestion and a unique method to combine an open surgical approach with endovascular embolization to treat CCFs.

  • arteriovenous malformation
  • fistula
  • vascular malformation
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Footnotes

  • Competing interests None declared.

  • Patient consent Obtained.

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

  • Data sharing statement There is no additional unpublished data from this study.

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