PMC5223754_01
CT bone image and 3D reconstruction (A) showing absence of the resected pterygoid process, and a bony spicule adjacent to the foramen lacerum (open circle). CT (B) and T2-weighted MRI (C) showed a left cerebellar hemorrhage and surrounding edema. CT: computed tomography, MRI: magnetic resonance imaging.
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The surgery included left maxillectomy and resection of the coronoid process of the mandible, inferior wall of the orbit, and part of the pterygoid process (Fig. 1A). Computed tomography and magnetic resonance imaging showed hemorrhage in the left cerebellar hemisphere with surrounding edema (Fig. 1B, C).
The internal carotid artery angiogram (A) just before embolization, showing a high-flow direct carotid-cavernous fistula, engorgement of the proximal superior petrosal sinus (black arrow) and petrosal vein (black arrowhead), stenosis of the posterior segment of the superior petrosal sinus, and narrowing of the sigmoid sinus ostia (white arrow). B: Lateral view of the left carotid angiogram after embolization, showing disappearance of the fistula, cortical reflux, and occlusion of the internal carotid artery. C: Frontal view of the right internal carotid artery angiogram after embolization, showing left middle cerebral artery via anterior communicating artery and no visualization of the left internal carotid artery or the carotid-cavernous fistula.
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The left SOV, anterior segment of the left SPS, left cerebellar veins, and left petrosal vein were all engorged (Fig. 2A). The fistula and abnormal drainage disappeared after embolization (Fig. 2B, C).