PMC5369261_01
Axial views of brain MRI showing a vascular abnormality of high flow in the left cavernous sinus compatible with an arterialized superior ophthalmic vein
SNI-8-36-g001.jpg
PMC5369261_01_SNI-8-36-g001.jpg
F1
A brain magnetic resonance image (MRI) [Figure 1] showed an oval structure of 14 x 13 x 11 mm adjacent to the left cavernous sinus.
DSA showing the indirect carotid cavernous fistula
SNI-8-36-g002.jpg
PMC5369261_01_SNI-8-36-g002.jpg
F2
The fistula was indirect [Figure 2] because it filled the cavernous sinus retrogradely through an abnormal communication between the final segment of the posterior petrous portion of the ICA and veins draining to the sinus (vidian artery communicating with the inferolateral trunk).
Normal DSA of the right ICA, posterior circulation, and both external carotid arteries
SNI-8-36-g003.jpg
PMC5369261_01_SNI-8-36-g003.jpg
F3
There was no other vascular abnormality involving the right ICA and external carotid artery bilaterally or posterior circulation [Figure 3].
Endovascular microcatheterization of the left ICA showing the CCF and its treatment with coil embolization
SNI-8-36-g004.jpg
PMC5369261_01_SNI-8-36-g004.jpg
F4
Transarterial embolization of the fistulous orifice was performed using coils, with immediate cessation of early venous filling [Figure 4].