Fig 1. Patient 6. Ruptured left cavernous sinus aneurysm in a 70-year-old woman with bilateral exophthalmus, ophthalmoplegia, and decreased vision.

A, Frontal view of left internal carotid artery angiogram. High-flow CCF with venous drainage to both cavernous sinuses, superior ophthalmic veins, and inferior petrosal sinuses. There is some cortical venous drainage, but no filling of intracranial vessels.

B, Right carotid angiogram demonstrates overflow to the left side and some contribution to the CCF.

C, Early arterial phase shows the aneurysm.

D, Coiling with balloon protection of the carotid artery.

E and F, Closure of the CCF with patency of the internal carotid artery.