Carotid cavernous fistula after percutaneous balloon compression for trigeminal neuralgia: Endovascular treatment with coils
- Department of Neurosurgery and Interventional Neuroradiology, University Hospital Cajuru of Catholic Pontifical University (HUC-PUC), Curitiba, Parana, Brazil
Luana A. M. Gatto
Department of Neurosurgery and Interventional Neuroradiology, University Hospital Cajuru of Catholic Pontifical University (HUC-PUC), Curitiba, Parana, Brazil
DOI:10.4103/sni.sni_443_16Copyright: © 2017 Surgical Neurology International This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Luana A. M. Gatto, Rafaella Tacla, Gelson L. Koppe, Zeferino Demartini Junior. Carotid cavernous fistula after percutaneous balloon compression for trigeminal neuralgia: Endovascular treatment with coils. 14-Mar-2017;8:36
How to cite this URL: Luana A. M. Gatto, Rafaella Tacla, Gelson L. Koppe, Zeferino Demartini Junior. Carotid cavernous fistula after percutaneous balloon compression for trigeminal neuralgia: Endovascular treatment with coils. 14-Mar-2017;8:36. Available from: http://surgicalneurologyint.com/surgicalint_articles/carotid-cavernous-fistula-after-percutaneous-balloon-compression-for-trigeminal-neuralgia-endovascular-treatment-with-coils/
Background:Percutaneous ganglyolysis treatment of trigeminal neuralgia is rarely associated with vascular complications, such as hematoma, subarachnoid hemorrhage, and stroke. Internal carotid artery injury may also occur after misguided needle placement, particularly far posteriorly or medially, resulting in carotid cavernous fistula. Anatomical variations of the foramen ovale can predispose those complications.
Case Description:A young woman diagnosed with trigeminal neuralgia during 11 years was submitted to a balloon rhizotomy by percutaneous approach to the trigeminal ganglion, with severe intraoperative bleeding. Cavernous syndrome developed few hours later. Magnetic resonance imaging and digital subtraction angiography confirmed an indirect carotid cavernous sinus fistula, which was treated by one session of endovascular procedure using coils, achieving total occlusion of the fistula and total recovery of the symptoms.
Conclusions:Embolization with coils is a minimally invasive, safe, and effective procedure for the treatment of carotid cavernous fistulas, including those related to iatrogenic causes.
Keywords: Carotid-cavernous sinus fistula, embolization, endovascular procedures, rhizotomy, therapeutic, trigeminal neuralgia
Trigeminal neuralgia (TN) is a disturbing condition that affects 8 per 100,000 people annually,[
We report here a case of CCF following PBC treated successfully with transarterial coil embolization.
A 27-year-old woman with TN during 11 years in the left V2 and V3 divisions was submitted 6 years ago to microvascular decompression in the posterior fossa due to neurovascular conflict. Her symptoms disappeared for 4 years and she was resistant to standard drug therapy at the time. Percutaneous balloon rhizotomy was performed in another service. Massive bleeding during the procedure was described, and the patient presented with proptosis, eye pain, chemosis, and paralysis of extraocular movements in the left eye a few hours after the procedure, with worsening of symptoms over the following days. A brain magnetic resonance image (MRI) [
CCF as a complication of TN percutaneous treatments has been only barely reported.[
Except for Gokalp et al.,[
Although rare, incidental puncture of the internal carotid artery in its cavernous segment during percutaneous balloon compression for TN is an already well-described complication. Treatment varies according to the angiographic flow pattern of CCF and the patient's symptoms, which can vary in intensity and time of evolution. With modern current endovascular devices, it is possible to carry out the treatment successfully avoiding open surgery.
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Conflicts of interest
There are no conflicts of interest.
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