Initial Diagnosis and Evaluation with Source and Reformatted MRA Images for Direct Carotid Cavernous Fistula (d-CCF) Caused by a Ruptured Cavernous Sinus Aneurysm and Successfully Treated with Stent-assisted Coil Embolization: A Case Report

Abstract

Objective: We present a case of direct carotid cavernous fistula (d-CCF) caused by a ruptured cavernous sinus aneurysm treated with stent-assisted coil embolization successfully. MRA source and reformatted images were helpful for the initial diagnosis and evaluation of the d-CCF.

Case Presentation: A 73-year-old female complained sudden onset of right exophthalmos, conjunctival congestion, and diplopia without a previous history of head trauma. MRA source images revealed a d-CCF draining into the right superior ophthalmic vein, sphenoparietal sinus, and superficial middle cerebral vein in a retrograde manner through the fistula of a ruptured cavernous sinus aneurysm. The location and size of the aneurysmal neck and the fistula were suggested on the MRA source and reformatted images, and confirmed on 3D-CTA and rotational angiography (RA). The lesion was successfully treated with stent-assisted coil embolization in a relatively short time, and her symptoms disappeared completely soon after the procedure.

Conclusion: Source and reformatted images of MRA were helpful for the initial diagnosis and evaluation of the d-CCF caused by a ruptured aneurysm. Stent-assisted coil embolization based on the pretreatment images including MRA images was an effective treatment for the d-CCF, as completed in a shorter time and was inexpensive than transvenous cavernous sinus coil packing.