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AJNR - American Journal of Neuroradiology

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Transvenous Embolization of a Direct Carotid Cavernous Fistula through the Pterygoid Plexus

Galen F.H. Chun^a and Thomas A. Tomsick^a,b

^a Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH
^b Section of Neuroradiology, University of Cincinnati Medical Center, Cincinnati, OH

View larger version (137K): [in a new window]   FIG 1. Lateral-projection angiogram of the left common carotid artery shows a direct carotid cavernous fistula, with the ostium in the inferior C4 portion of the ICA just anterior to the posterior genu. Fistulous flow to the cavernous sinus, with effluence to an attenuated superior ophthalmic vein, a single channel connecting to the pterygoid plexus, is present. No inferior petrosal sinus opacified.

View larger version (133K): [in a new window]   FIG 2. Venous-phase angiogram shows the pterygoid plexus, maxillary veins, facial vein, and retromandibular-external jugular vein channels.

View larger version (162K): [in a new window]   FIG 3. Rapid Transit microcatheter has been passed into the cavernous sinus via the pterygoid plexus. Injection of contrast medium shows the venous compartment.

View larger version (168K): [in a new window]   FIG 4. Injection of the left common carotid artery after placement of standard and fibered GDC shows complete occlusion of the fistulous flow.