Ruptured Cavernous Sinus Aneurysms Causing Carotid Cavernous Fistula: Incidence, Clinical Presentation, Treatment, and Outcome
W.J. van Rooija,
M. Sluzewskia and
G.N. Beuteb
a Department of Radiology, St. Elisabeth Ziekenhuis, Tilburg, the Netherlands
b Department of Neurosurgery, St. Elisabeth Ziekenhuis, Tilburg, the Netherlands
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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.
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Fig 2. Patient 9. Ruptured right cavernous sinus aneurysm in a 74-year-old woman with bilateral exophthalmus, ophthalmoplegia, and decreased vision.
A and B, Frontal (A) and lateral (B) view of right internal carotid artery angiogram. Principal venous drainage to both cavernous sinuses and superior ophthalmic veins. There is some cortical venous drainage.
C and D, Arterial (C) and venous (D) phase of left internal carotid angiogram during test occlusion of the right internal carotid artery. Synchronous opacification of cortical veins in both hemispheres indicates tolerance to permanent occlusion.5
E, Occlusion of the ruptured aneurysm, including the internal carotid artery, with coils.
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Fig 3. Patient 4. CCF in a 61-year-old woman with bilateral exophthalmus, ophthalmoplegia, and decreased vision.
A, Lateral view of left internal carotid angiogram shows CCF with principal venous drainage to both cavernous sinuses and superior ophthalmic veins. There is some cortical venous drainage.
B, Early arterial phase shows small cavernous aneurysm.
C and D, Selective occlusion of the aneurysm with a detachable balloon.
E and F, Follow-up angiogram after 4 months shows reopening and enlargement of the aneurysm, subsequently occluded with coils.
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