Carotid cavernous fistula associated with persistent trigeminal artery: Endovascular treatment using coil embolization

Carotid-cavernous fistula (CCF) associated with persistent trigeminal arter y (PTA) is a rate but important clinical entity. We present a case treated by microcoil embolization with preservation of internal carotid, PTA, and b asilar artery flow following embolization. A 62-year-old female developed p ulsatile tinnitus followed by left eye proptosis and diplopia. Examination revealed a cranial nerve VI palsy and an objective bruit over the left orbi t. Angiographic evaluation revealed a carotid cavernous fistula originating from a persistent trigeminal, artery Placement of a detachable balloon acr oss the fistula site while preserving the PTA proved impossible, and the fi stula was treated with microcoils following placement of a microcatheter ac ross the fistula into the cavernous sinus. Complete closure of the fistula was followed by resolution of the patient's symptoms. Preservation of all m ajor vessels including the PTA was accomplished through the use of coil emb olization. Careful evaluation of the angiogram is necessary to identify PTA associated with a CCF Previous reports have described treatment of CCF wit h PTA by surgical or balloon occlusion, some involving sacrifice of the PTA . Examination of the relevant embryology and anatomy reveals, however, that occlusion of the PTA must be approached with caution due to potential supp ly to the posterior circulation.