PMC10158662_01
Magnetic resonance imaging demonstrating frontal basal lobe edema (arrow) and congestion
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Magnetic resonance imaging (MRI) demonstrated significant inflammation involving the right orbit and atypical enhancement of the basal frontal lobe adjacent to the orbit [Figure 1].
Time-of-flight magnetic resonance angiography with carotid cavernous fistula demonstrating enlarged superior ophthalmic vein (arrow), right internal carotid artery, and cavernous sinus
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Magnetic resonance angiography (MRA) with time-of-flight demonstrated an enlarged superior ophthalmic vein, cavernous sinus, and enlarged frontal vein [Figures 2 and 3].
Magnetic resonance angiography with carotid-cavernous fistula, superior ophthalmic vein (solid arrow), cavernous sinus (dashed arrow), and enlarged frontal vein corresponding to the area of cortical vein on MRI. MRI: Magnetic resonance imaging
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F3
Magnetic resonance angiography (MRA) with time-of-flight demonstrated an enlarged superior ophthalmic vein, cavernous sinus, and enlarged frontal vein [Figures 2 and 3].
Digital subtraction angiography before embolization demonstrating basal frontal vein (solid arrow), superior ophthalmic vein (dashed arrow), and inferior petrosal sinus (block arrow) with no drainage due to occlusion
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Figure 4 illustrates the basal frontal vein, superior ophthalmic vein, and occluded inferior petrosal sinus on digital subtraction angiography before embolization.
Digital subtraction angiography (a) lateral view of the right internal carotid artery run with early opacification of the right cavernous sinus. (b) lateral view of the right internal carotid artery runs post-Onyx and coil
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The fistula was successfully treated with transvenous approach through the right inferior petrosal sinus using a coil and Onyx liquid embolic agent [Figure 5].
Magnetic resonance imaging FLAIR images showing (a) edema from venous congestion and (b) significant improvement after treatment. FLAIR: Fluid-attenuated inversion recovery
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MRI since his discharge noted improvement in edema involving the right basal frontal lobe with complete resolution of orbital findings [Figure 6].