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Case Reports
. 2001 Mar;22(3):537-40.

Transsphenoidal computer-navigation-assisted deflation of a balloon after endovascular occlusion of a direct carotid cavernous sinus fistula

J Klisch  1 , J Schipper, H Husstedt, R Laszig, M Schumacher
Affiliations
Case Reports

Transsphenoidal computer-navigation-assisted deflation of a balloon after endovascular occlusion of a direct carotid cavernous sinus fistula

J Klisch et al. AJNR Am J Neuroradiol. 2001 Mar.

Abstract

A 49-year-old woman with a direct posttraumatic carotid cavernous fistula (CCF) was treated with detachable balloons via a transcarotid route. After the procedure, her intracranial bruit, conjunctival injection, and orbital congestion were cured, but the preexistent sixth nerve palsy deteriorated. CT showed one balloon positioned in the posterior portion of the right cavernous sinus and was regarded to be responsible for nerve compression. After surgical exposure by use of a transnasal-transsphenoidal approach under 3D navigation control, this balloon was deflated by puncture with a 22-gauge needle. The previously described symptoms resolved after balloon deflation. This report presents a rare complication of endovascular treatment of direct CCF and a new microsurgical approach to a balloon in a case of nerve compression.

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Figures

<sc>fig</sc> 1.
fig 1.
A, Angiogram of right ICA before embolization (anteroposterior view, early arterial phase) shows huge CCF and no opacification of intracranial vessels. B, Lateral angiogram of the right ICA shows CCF drainage by the right superior ophthalmic vein, both CS, the inferior petrosal sinus, and pterygoid sinus. C, Left ICA angiogram before embolization (anteroposterior view, early arterial phase) shows cross flow via the anterior communicating artery.
<sc>fig</sc> 2.
fig 2.
The anatomic location of the detached balloons shown by CT (3D view)
<sc>fig</sc> 3.
fig 3.
CT navigation for surgery focuses the pointer on the area of the posterior wall of the sphenoid sinus, where the bone was opened
<sc>fig</sc> 4.
fig 4.
A and B, X-ray documentation of the two balloons located in the CS and ICA at the fistula site (A, before treatment; B, control taken 7 days after balloon puncture). The third balloon in the petrous segment of the ICA is superimposed by skull base structures (see figure 2)
See this image and copyright information in PMC

References

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