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AJNR - American Journal of Neuroradiology

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Transsphenoidal Computer-navigation–assisted Deflation of a Balloon after Endovascular Occlusion of a Direct Carotid Cavernous Sinus Fistula

Joachim Klisch^,a, Jörg Schipper^a, Hartmut Husstedt^a, Roland Laszig^a and Martin Schumacher^a

^a From the Departments of Neurosurgery, Section of Neuroradiology (J.K., H.H., M.S.) and Otolaryngology and Head and Neck (J.S., R.L.), University of Freiburg, Freiburg, Germany.

View larger version (54K): [in a new window]   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.

View larger version (94K): [in a new window]   FIG 2. The anatomic location of the detached balloons shown by CT (3D view)

View larger version (84K): [in a new window]   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

View larger version (71K): [in a new window]   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)