Spontaneous Persistent Primitive Trigeminal Artery-Cavernous Sinus Fistula Successfully Treated by Multipronged Coil Embolization: Case Report and Literature Review.
Abducens Nerve Diseases
/ etiology
Angiography, Digital Subtraction
Arteriovenous Fistula
/ complications
Basilar Artery
/ diagnostic imaging
Carotid Artery, Internal
/ diagnostic imaging
Cavernous Sinus
/ diagnostic imaging
Embolization, Therapeutic
/ methods
Endovascular Procedures
/ methods
Female
Headache
/ etiology
Humans
Magnetic Resonance Angiography
Middle Aged
Cavernous sinus
Embolization
Fistulae
Multipronged
Persistent primitive trigeminal artery
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
Aug 2019
Aug 2019
Historique:
received:
08
03
2019
revised:
30
04
2019
accepted:
02
05
2019
pubmed:
13
5
2019
medline:
21
1
2020
entrez:
13
5
2019
Statut:
ppublish
Résumé
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. 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. The multipronged approach is safe and effective for embolization of a small tortuous artery and shunt segment to avoid incomplete shunt occlusion.
Sections du résumé
BACKGROUND
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
METHODS
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
CONCLUSIONS
The multipronged approach is safe and effective for embolization of a small tortuous artery and shunt segment to avoid incomplete shunt occlusion.
Identifiants
pubmed: 31078800
pii: S1878-8750(19)31276-8
doi: 10.1016/j.wneu.2019.05.003
pii:
doi:
Types de publication
Case Reports
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
122-126Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.