Traumatic carotid-rosenthal fistula treated with Jostent Graftmaster

Abstract

Traumatic injuries of the carotid artery may result in severe morbidity and mortality. The most common location of carotid artery injury is the cavernous segment, which may result in fistulous connection to the cavernous sinus and ophthalmic veins, which in turn lead to pressure symptoms in the ipsilateral orbit. Unlike the commonly reported direct traumatic carotid-cavernous fistula, we describe an unusual case of a 38-year-old man presented with a traumatic brain injury led to a fistula connection between the cavernous carotid artery and the ipsilateral basal vein of Rosenthal, with eventual drainage to the straight and transverse sinuses. The basal vein of Rosenthal is usually formed from confluence of anterior and middle cerebral veins deep in the Sylvian fissure and drain the insular cortex and the cerebral peduncles to the vein of Galen. Immediate endovascular deployment of a covered stent in the cavernous carotid artery allowed sealing the laceration site. Three months follow up showed a non-focal neurological examination and healed carotid laceration over the covered stent.

Keywords: Carotid artery; Fracture; Jostent; Skull base; Trauma.

Figure 1

Left internal carotid artery angiogram in the AP and lateral views (arterial phase: A and B; capillary phase: C and D; and following the deployment of the Jostent Graftmaster: E and F). White arrows show the contrast extravasations at the cavernous segment pointing posteriorly with early venous filling to the internal cerebral vein, straight and lateral venous sinuses (black arrows). White arrow heads shows Jostent Graftmaster in position with decreased contrast extravasations.

Figure 2

Three months follow up evaluation shows a normal brain magnetic resonance imaging (FLAIR A and B); left internal carotid angiogram (C: AP view, D: Lateral view) shows a normal flow through the Jostent Graftmaster in the cavernous segment (white arrows).