Endovascular Management of A Traumatic Carotid Cavernous Fistula Accompanied By A Pseudoaneurysm: A Case Report

Abstract

Objective Carotid caverneous fistula (CCF) accompanied by a pseudoaneurysm is a rare life-threatening condition that requires emergency treatment. Herein, we report a case of traumatic CCF accompanied by a pseudoaneurysmal intracranial hemorrhage from the intradural internal carotid artery. Case A man aged 29 years developed a traumatic intracranial hemorrhage after a motor vehicle accident. Cerebral computed tomography (CT) showed an acute subdural hematoma on the left frontal and temporal lobes. There was also an intracranial hemorrhage in the left inferior frontal lobe and a diffuse subarachnoid hemorrhage involving the prepontine cistern, basal cistern, bilateral sylvian fissure, and interhemispheric fissure. Decompressive craniectomy was immediately performed. In a follow-up CT, contrast extravasation in the left inferior frontal lobe with simultaneous venous filling in the left cavernous sinus was detected, concomitant with a high-flow CCF. Cerebral angiography showed that a CCF developed in the left internal carotid artery and a pseudoaneurysm was also detected above the CCF. The fistula was occluded through coil embolization and the pathologic lesions were covered with stents resulting in the disappearance of the fistula and pseudoaneurysm. Conclusion Endovascular stent-assisted coil embolization can be successfully performed in this rare fatal disease without complications.