Abstract：
BACKGROUND:A spontaneous persistent primitive trigeminal artery-cavernous sinus fistula (PCF) is extremely rare. Until recently, endovascular treatment for PCF involving transarterial and/or transvenous coil embolization of the cavernous sinus (with/without the persistent trigeminal artery) was commonly performed. However, it may result in remaining shunt flow or exacerbation of cranial nerve palsy. CASE DESCRIPTION:A 51-year-old woman presented with headache and left abducens palsy. Digital subtraction angiography demonstrated a direct fistula between the cavernous segment of the persistent primitive trigeminal artery (PPTA) and posterosuperior compartment of the left cavernous sinus (CS). Three microcatheters were guided into the fistula as follows: 1) through the PPTA to the CS from the left internal carotid artery, 2) through the PPTA to the CS from the basilar artery, and 3) through the CS to the PPTA from the internal jugular vein. Using the double-catheter technique in a multidirectional fashion, shunt occlusion was achieved with a small number of coils. No signs of recurrence were observed during the follow-up period. CONCLUSIONS:The multipronged approach is safe and effective for embolization of a small tortuous artery and shunt segment to avoid incomplete shunt occlusion.
journal_name
World Neurosurgjournal_title
World neurosurgeryauthors
Ishiguro T,Satow T,Okada A,Hamano E,Ikeda G,Chikuie H,Koiso T,Hashimura N,Nishimura M,Takahashi JCdoi
10.1016/j.wneu.2019.05.003subject
Has Abstractpub_date
2019-08-01 00:00:00pages
122-126eissn
1878-8750issn
1878-8769pii
S1878-8750(19)31276-8journal_volume
128pub_type
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