PMC10115948_01
A visual manifestation and instrumental examinations of Case 1. (A) Anterior view. (B) Lateral view. (C) Axial MRI shows dilatation of the superior ophthalmic vein in a patient with left side carotid-cavernous fistula. (D) Digital subtraction angiogram (lateral view) shows a dural carotid-cavernous fistula drained anteriorly and posteriorly with a combination of extra cranial internal carotid aneurysm.
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fig1
In both cases, magnetic resonance imaging (thereafter - MRI) revealed enlarged cavernous sinuses and enlarged superior and inferior ophthalmic veins (Figures 1C, 2A). Moreover, dissecting aneurysms at the extracranial part of the left (first case) and right (second case) ICAs were detected (Figures 1D, 2B).
PMC10115948_02
A visual manifestation and instrumental examinations of Case 1. (A) Anterior view. (B) Lateral view. (C) Axial MRI shows dilatation of the superior ophthalmic vein in a patient with left side carotid-cavernous fistula. (D) Digital subtraction angiogram (lateral view) shows a dural carotid-cavernous fistula drained anteriorly and posteriorly with a combination of extra cranial internal carotid aneurysm.
fneur-14-1120786-g001.jpg
PMC10115948_02_fneur-14-1120786-g001.jpg
fig1
In both cases, magnetic resonance imaging (thereafter - MRI) revealed enlarged cavernous sinuses and enlarged superior and inferior ophthalmic veins (Figures 1C, 2A). Moreover, dissecting aneurysms at the extracranial part of the left (first case) and right (second case) ICAs were detected (Figures 1D, 2B).
An instrumental examination of Case 2. (A) Axial MRI revealed enlargement of the superior ophthalmic vein and expansion of the right cavernous sinus in a patient with right side carotid-cavernous fistula. (B) Preoperative angiogram. (C) Postoperative control angiograms reveal stent deployment and aneurysm exclusion from the blood circulation. Anterior-posterior projection. (D) Lateral view. (E) Post-procedural angiograms (follow-up after 6 months). Anterior view. (F) Post-procedural angiograms (follow-up after 6 months). Lateral view.
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fig2
In both cases, magnetic resonance imaging (thereafter - MRI) revealed enlarged cavernous sinuses and enlarged superior and inferior ophthalmic veins (Figures 1C, 2A). Moreover, dissecting aneurysms at the extracranial part of the left (first case) and right (second case) ICAs were detected (Figures 1D, 2B). Multiple control angiograms showed the exclusion of the aneurysm from the blood circulation (Figures 2C,D, 4C,D). Control angiography was performed 6 months later on one patient (Figures 2E,F) and revealed complete occlusion of ECAA and CCF.
Intraoperative angiograms. Digital subtraction angiograms from internal carotid artery. (A) Anterior-posterior projection view, Case 1. (B) Lateral view, Case 1. (C) Anterior-posterior projection view, Case 2. (D) Lateral view, Case 2.
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It was compared with the initial angiogram to rule out embolic events and confirm complete fistula obliteration (Figure 3).
Postoperative images, Case 1. (A) Anterior view. (B) Lateral view. (C) Postoperative control angiograms show complete occlusion of the CCFs with coil mass. Anterior-posterior projection view. (D) Lateral view.
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fig4
Proptosis and chemosis resolved the next day in both patients (Figures 4A,B). Multiple control angiograms showed the exclusion of the aneurysm from the blood circulation (Figures 2C,D, 4C,D).