Transsphenoidal computer-navigation-assisted deflation of a balloon after endovascular occlusion of a direct carotid cavernous sinus fistula

A 49-year-old woman with a direct posttraumatic carotid cavernous fistula ( CCF) was treated with detachable balloons via a transcarotid route. After t he procedure, her intracranial bruit, conjunctival injection, and orbital c ongestion were cured, but the preexistent sixth nerve palsy deteriorated. CT showed one balloon positioned in the posterior portion of the right cave rnous sinus and was regarded to be responsible for nerve compression. After surgical exposure by use of a transnasal-transsphenoidal approach under 3D navigation control, this balloon was deflated by puncture with a 22-gauge needle. The previously described symptoms resolved after balloon deflation. This re port presents a rare complication of endovascular treatment of direct CCF a nd a new microsurgical approach to a balloon in a case of nerve compression .