Traumatic persistent trigeminal artery--cavernous sinus fistula treated by transcatheter arterial embolization. A case report

Abstract

We describe a rare case of traumatic persistent trigeminal artery (PTA) - cavernous sinus fistula. Cerebral angiography showed direct communication between the right PTA and the cavernous sinus which was treated by transcathether arterial embolization. Although previous reports have indicated the use of more coils to treat this condition, we successfully treated the patient with only two coils placed near the orifice of the fistula after sufficient anatomical evaluation.

Figure 1

Axial (A-C) and sagittal (D) views of computed tomography angiography. Axial view of magnetic resonance angiography (E). A-C) The right cavernous sinus is distended. Dilated superior ophthalmic vein (full arrowheads) and sphenoparietal sinus (empty arrowheads) are visualized, indicating drainage veins. A,D) The origin and cisternal portion of the persistent trigeminal artery are indicated (arrows). E) The cisternal portion of the right PTA is indicated by an arrow. The origin of the PTA and fistulous point is obscured.

Figure 2

A) Right internal carotid arteriogram, the cavernous sinus (arrows) and dilated SOV (full arrowheads) are seen in a lateral view, revealing the origin of the PTA (empty arrowhead). B) Left vertebral arteriogram, lateral view, showing the cisternal portion of the PTA (arrows) filling the fistula, indicating the PTA-cavernous sinus fistula. The cavernous sinus and dilated cortical veins (arrowheads) are also shown.

Figure 3

A,B) Lateral oblique view during transarterial embolization. B) A microcatheter was inserted into the fistula, and the two GDC vortex coils were deployed to occlude the fistula. C) Right internal carotid arteriogram after coiling reveals a complete occlusion of the fistula. There is a connection between the preserved PTA (arrows) and the basilar artery (arrowheads). D) The left vertebral arteriogram shows filling of the PTA (arrows).