Silveira Luke A, Delahmetovic Elnur, Bounajem Michael, Thakrar Raj, Ducis Katrina, Raymond Scott, Liebelt Brandon
Division of Neurosurgery, The University of Vermont Medical Center, Burlington, Vermont.
Department of Neurosurgery, The University of Utah, Salt Lake City, Utah.
J Neurosurg Case Lessons. 2024 Sep 9;8(11). doi: 10.3171/CASE24287.
A carotid-cavernous fistula (CCF) is a well-recognized entity resulting from an abnormal connection between the internal carotid artery (ICA) or external carotid artery and the cavernous sinus. Typical CCF symptomology includes proptosis, chemosis, orbital bruit, headache, facial pain, and cranial nerve (CN) palsies. While CCFs most often occur posttraumatically, they can also occur spontaneously, secondary to cavernous ICA aneurysm rupture. Very rarely, they can occur secondary to the rupture of an anomalous persistent trigeminal artery (PTA) aneurysm.
Herein, the authors describe the case of a 54-year-old woman who presented with a CN VI palsy and headache due to a CCF secondary to a PTA aneurysm rupture. The CCF was ultimately treated via coil embolization of the aneurysm and the parent PTA vessel.
Though such occurrences are rare, clinicians should be vigilant in assessing for the presence of a PTA in patients with a CCF, as a PTA-associated CCF requires unique treatment considerations. In some cases where the PTA plays a crucial role in the posterior circulation supply, preservation of the parent vessel PTA is crucial. However, in cases in which an adequate posterior circulation collateral supply exists, embolization of the aneurysm and the parent vessel PTA is a reasonable treatment option for fistula closure. https://thejns.org/doi/10.3171/CASE24287.
颈动脉海绵窦瘘（CCF）是一种公认的疾病，由颈内动脉（ICA）或颈外动脉与海绵窦之间的异常连接引起。典型的CCF症状包括眼球突出、结膜水肿、眼眶杂音、头痛、面部疼痛和脑神经（CN）麻痹。虽然CCF最常发生于外伤后，但也可自发发生，继发于海绵窦ICA动脉瘤破裂。非常罕见的情况下，它们可继发于异常持续三叉动脉（PTA）动脉瘤破裂。
在此，作者描述了一例54岁女性因PTA动脉瘤破裂继发CCF而出现CN VI麻痹和头痛的病例。该CCF最终通过对动脉瘤和母PTA血管进行弹簧圈栓塞治疗。
尽管此类情况罕见，但临床医生在评估CCF患者时应警惕PTA的存在，因为与PTA相关的CCF需要独特的治疗考虑。在某些情况下，PTA在供应后循环中起关键作用，保留母血管PTA至关重要。然而，在存在足够的后循环侧支供应的情况下，对动脉瘤和母血管PTA进行栓塞是闭合瘘管的合理治疗选择。https://thejns.org/doi/10.3171/CASE24287 。
