PMC10475581_01
Preoperative CTA imaging showed that there was an abnormal vascular mass in the right cavernous sinus area, and prominent vascular structures could be seen around the medulla.
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Upon admission, an urgent cranial CT scan showed no significant abnormalities, while head and neck computed tomography angiography (CTA) demonstrated an anomalous vascular mass in the right cavernous sinus area, contiguous with the internal carotid artery (ICA), accompanied by dilated and tortuous perimedullary vascular structures (Figure 1).
MRI examination of the affected region. The MRI scan reveals medullary and cervical cord edema with multiple tortuous vascular flow voids (A). Additionally, tortuous vascular flow voids are also observed in the thoracic and lumbar cord regions (B).
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The patient's spinal cord magnetic resonance imaging (MRI) examination revealed medullary and cervical cord edema, along with multiple tortuous vascular flow voids (Figure 2).
Angiography of right internal carotid artery. The preoperative DSA showed that the cavernous sinus was abnormally filled and blood flowed back through the perimedullary vein (A). Intraoperative DSA for coil embolization (B). After embolization of the cavernous sinus with arterial coil, the fistula was completely occluded (C).
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Subsequently, a cerebral angiography was expeditiously conducted, with the digital subtraction angiography (DSA) revealing a high-flow CCF on the right side draining into the intraspinal venous plexus and cerebellar vein (Figure 3A). Utilizing precise placement, five coils were deployed to embolize and effectively occlude the abnormal arteriovenous communication (Figure 3B). The entire procedure was smoothly executed, and immediate post-interventional DSA demonstrated successful closure of the fistula, absence of draining veins, and preservation of the integrity of the ICA (Figure 3C).