Bilateral Persistent Trigeminal Arteries with Unilateral Trigeminal Artery to Cavernous Sinus Fistula

A 59-year-old man who denied a history of trauma presented with left pulsatile tinnitus and left orbital swelling for six months. Digital subtraction angiography showed a left persistent trigeminal artery (PTA) with a trigeminal artery to cavernous sinus (trigeminal-cavernous sinus) fistula and a right PTA. Transarterial detachable coil embolization of the left trigeminal-cavernous sinus fistula was performed, and the symptoms subsided. There has been no report of bilateral PTAs with a spontaneous fistula connected from one PTA to the ipsilateral cavernous sinus. This paper reports such a rare circumstance.

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Abstract 158: Magnetic Resonance Digital Subtraction Angiography Identifies Impaired Drainage in Arteriovenous Malformations With History of Rupture

Stroke ◽

10.1161/str.45.suppl_1.158 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Justin E Vranic ◽

Parmede Vakil ◽

Sameer A Ansari ◽

Hunt H Batjer ◽

Bernard R Bendok ◽

...

Keyword(s):

Digital Subtraction Angiography ◽

Arteriovenous Malformations ◽

Incidental Finding ◽

Whole Body ◽

Digital Subtraction ◽

Focal Neurological Deficit ◽

History Of ◽

Vein Yellow ◽

The Mean ◽

Time Density

BACKGROUND: Cerebral digital subtraction angiography (DSA) has established impaired hemodynamic drainage of intracranial arteriovenous malformations (iAVM) as a risk factor for iAVM hemorrhage. Unlike conventional DSA, MR-DSA offers a noninvasive means of characterizing iAVM hemodynamics. We hypothesize that MR-DSA will demonstrate impaired drainage in iAVMs with history of rupture when compared to iAVMs without history of rupture. METHODS: Consecutive patients with untreated, DSA-confirmed iAVM underwent MR-DSA on a 3T Whole-body MR-scanner. For each iAVM, regions of interest (ROI) were drawn on all feeder arteries and draining veins. Time-density curves were constructed for each ROI. The arteriovenous malformation transit time (ATT) was defined for each ROI as the time between contrast arrival and peak intravascular contrast density on the MR time-density curve. The drainage of each iAVM was characterized by the ratio of the draining vein ATT to the mean feeder artery ATT. The ATT ratio was compared between iAVMs with history of hemorrhage and those without. Statistical analysis was performed using a Student’s unpaired t-test with p <0.05 defined as statistically significant. RESULTS: From May 2011 to April 2012, 13 patients (7M:6F, 40.6±13.8 years old) were enrolled in our study, with 3 patients presenting with history of hemorrhage and the remainder presenting with history of seizure, focal neurological deficit, headache, or as an incidental finding. The ATT ratio was significantly higher in iAVMs with history of hemorrhage than in those without (1.17±0.06 vs 0.95±0.02, p <2.9E-7). CONCLUSION: MR-DSA identifies impaired drainage in iAVMs with history of rupture without exposing patients to the procedural risks and ionizing radiation associated with cerebral DSA. FIGURE A: MR-DSA with feeder artery (red) and draining vein (yellow) labeled. FIGURE B: Time-density curves of the artery (red) and vein (yellow) from which vessel ATTs were derived.

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Traumatic Persistent Trigeminal Artery - Cavernous Sinus Fistula Treated by Transcatheter Arterial Embolization

Interventional Neuroradiology ◽

10.1177/159101991001600113 ◽

2010 ◽

Vol 16 (1) ◽

pp. 93-96 ◽

Cited By ~ 4

Author(s):

K. Asai ◽

K. Hasuo ◽

T. Hara ◽

T. Miyagishima ◽

N. Terano

Keyword(s):

Cavernous Sinus ◽

Cerebral Angiography ◽

Transcatheter Arterial Embolization ◽

Rare Case ◽

Arterial Embolization ◽

Persistent Trigeminal Artery ◽

Trigeminal Artery ◽

Direct Communication ◽

The Right

We describe a rare case of traumatic persistent trigeminal artery (PTA) - cavernous sinus fistula. Cerebral angiography showed direct communication between the right PTA and the cavernous sinus which was treated by transcathether arterial embolization. Although previous reports have indicated the use of more coils to treat this condition, we successfully treated the patient with only two coils placed near the orifice of the fistula after sufficient anatomical evaluation.

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Acute Brainstem Dysfunction Caused by Cavernous Sinus Dural Arteriovenous Fistula

Case Reports in Neurological Medicine ◽

10.1155/2020/2630959 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Yuwa Oka ◽

Kenichi Komatsu ◽

Soichiro Abe ◽

Naoya Yoshimoto ◽

Junya Taki ◽

...

Keyword(s):

Magnetic Resonance ◽

Arteriovenous Fistula ◽

Digital Subtraction Angiography ◽

Cavernous Sinus ◽

Dural Arteriovenous Fistula ◽

Inflammatory Diseases ◽

Digital Subtraction ◽

Arteriovenous Fistulas ◽

Ocular Symptoms ◽

Brainstem Dysfunction

Symptoms of cavernous sinus dural arteriovenous fistula depend on the drainage patterns and are very diverse. Among these, brainstem dysfunction is a rare but serious complication. Here, we describe a case with isolated and rapidly progressive brainstem dysfunction due to cavernous sinus dural arteriovenous fistula. An 80-year-old woman presented with a 2-day history of progressive gait disturbance. Neurological examination revealed mild confusion, dysarthria, and left hemiparesis. Magnetic resonance imaging (MRI) revealed pontine swelling without evidence of infarction. Magnetic resonance angiography suggested a faint abnormality near the cavernous sinus. Dural arteriovenous fistula was suspected, and digital subtraction angiography was planned for the next day. Her condition had progressed to coma by the next morning. Pontine swelling worsened, and hyperintensity appeared on diffusion-weighted imaging. Digital subtraction angiography revealed a right-sided cavernous sinus dural arteriovenous fistula with venous reflux into the posterior fossa. Orbital or ocular symptoms had preceded brainstem symptoms in all nine previously reported cases, but brainstem symptoms were the only presentation in our case, making the diagnosis difficult. Some dural arteriovenous fistulas mimic inflammatory diseases when the clinical course is acute. Prompt diagnosis using enhanced computed tomography or MRI and emergent treatment are needed to avoid permanent sequelae.

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A Poorly Treated Carotid-Cavernous Fistula Rescued by Coils through a PComA Approach

Interventional Neuroradiology ◽

10.1177/159101990901500210 ◽

2009 ◽

Vol 15 (2) ◽

pp. 197-201

Author(s):

J. Yu ◽

Z. Shi ◽

M. Lv ◽

X. Yang ◽

Z. Wu

Keyword(s):

Digital Subtraction Angiography ◽

Temporal Bone ◽

Cavernous Sinus ◽

Ophthalmic Artery ◽

Parent Artery ◽

Maxillary Artery ◽

Digital Subtraction ◽

Carotid Cavernous Fistula ◽

Puncture Wound ◽

Cavernous Fistula

This study describes a case of traumatic carotid-cavernous fistula poorly treated with balloons and rescued by coils through a PComA approach. A six-year-old boy suffered a left temporal bone puncture wound. Digital subtraction angiography disclosed a left carotid cavernous fistula. Five balloons were implanted into the cavernous sinus and the parent artery was sacrificed unwillingly, but the residual fistula retro-engorged by the ophthalmic artery communicated with the maxillary artery and the post circle through the PComA. We finally occluded the residual fistula through the PComA with coils. Once the parent artery was sacrificed and the distal residual fistula still retro-engorged, another patent communicating artery may be a rescue approach.

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Trigeminal artery to cavernous sinus fistula treated by balloon occlusion

Journal of Neurosurgery ◽

10.3171/jns.1983.58.4.0611 ◽

1983 ◽

Vol 58 (4) ◽

pp. 611-613 ◽

Cited By ~ 21

Author(s):

Charles W. Kerber ◽

William Manke

Keyword(s):

Carotid Artery ◽

Cavernous Sinus ◽

Femoral Artery ◽

Balloon Occlusion ◽

Persistent Trigeminal Artery ◽

Trigeminal Artery ◽

Content Type ◽

Flow Through ◽

Sinus Flow ◽

Fine Print

✓ A spontaneous cavernous sinus fistula developed following presumed sinusitis, and was found to originate not from the carotid artery but from a persistent trigeminal artery. The fistula was treated by introducing a detachable latex balloon via a femoral artery approach through the trigeminal artery and then into the cavernous sinus. Flow through the carotid, vertebral, and trigeminal arteries was preserved.

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Evaluation of intra-aneurysmal blood flow by digital subtraction angiography: blood flow change after coil embolization

Surgical Neurology ◽

10.1016/s0090-3019(02)01045-5 ◽

2003 ◽

Vol 59 (4) ◽

pp. 309-318 ◽

Cited By ~ 19

Author(s):

Fumio Asakura ◽

Hiroshi Tenjin ◽

Noriaki Sugawa ◽

Satoshi Kimura ◽

Fumiya Oki

Keyword(s):

Blood Flow ◽

Digital Subtraction Angiography ◽

Coil Embolization ◽

Digital Subtraction ◽

Blood Flow Change ◽

Flow Change

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Stent-assisted coil embolization on down-the-barrel view with spring-shaped microcatheter in patient with M1 ultrawide necked circumferential aneurysm

BMJ Case Reports ◽

10.1136/bcr-2017-013597 ◽

2018 ◽

pp. bcr-2017-013597

Author(s):

Hyo Sung Kwak ◽

Jung Soo Park ◽

Eun Jeong Koh

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Middle Cerebral Artery ◽

Digital Subtraction Angiography ◽

Cerebral Artery ◽

Coil Embolization ◽

Digital Subtraction ◽

Safe Technique ◽

Delayed Complications

Herein, we describe a technique for stent-assisted coil embolization with a spring-shaped microcatheter in a patient with an M1 ultrawide-necked circumferential aneurysm in the middle cerebral artery (MCA). A 49-year-old man was referred for treatment of an incidentally detected M1 large-circumference aneurysm on magnetic resonance angiography. Subsequent digital subtraction angiography revealed an 18.2×16.5 mm ultrawide-necked circumferential aneurysm on the distal M1 portion of the left MCA, and we planned stent-assisted coil embolization using a spring-shaped microcatheter. After we deployed the stent, we performed coil embolization under the down-the-barrel view by pulling out the microcatheter little by little. Using this technique, we could fill the coil mass evenly into the aneurysmal sac around the stent. And there were no immediate or delayed complications after the procedure. Stent-assisted coiling using a spring-shaped microcatheter is a useful and safe technique for treating ultrawide-necked circumferential aneurysm or fusiform aneurysms.

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Carotid-cavernous fistula caused by laceration of persistent fetal trigeminal artery treated with single catheter coil embolization

Indian Journal of Neurosurgery ◽

10.4103/2277-9167.94375 ◽

2012 ◽

Vol 01 (01) ◽

pp. 072-074

Author(s):

Anthony Sin ◽

Hugo Cuellar ◽

Benjamin Brown

Keyword(s):

Endovascular Treatment ◽

Cavernous Sinus ◽

Coil Embolization ◽

Internal Carotid ◽

Trigeminal Artery ◽

Carotid Cavernous Fistula ◽

Unique Challenge ◽

Cavernous Fistula ◽

Catheter Technique ◽

Safe Treatment Option

Abstract We present the endovascular treatment of traumatic carotid-cavernous fistula from persistent fetal trigeminal artery (PFTA) laceration. To date, there are six such cases of traumatic PFTA-cavernous fistulas reported in the literature. These injuries can pose a unique challenge in that rupture of a PFTA in its course through the cavernous sinus may produce a fistula feeding from both anterior and posterior circulations. Previously, these have been treated with dual catheter coil embolization from the carotid and basilar systems. We utilize a single catheter technique accessing the cavernous sinus through the origin of the PFTA on the internal carotid. Both anterior and posterior fistula components may be embolized through this single access. This represents a simple yet safe treatment option.

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Progressive thrombosis of unruptured aneurysms after coil embolization: analysis of 255 consecutive aneurysms

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2019-014775 ◽

2019 ◽

Vol 11 (11) ◽

pp. 1113-1117 ◽

Cited By ~ 1

Author(s):

Yusuke Funakoshi ◽

Hirotoshi Imamura ◽

Shoichi Tani ◽

Hidemitsu Adachi ◽

Ryu Fukumitsu ◽

...

Keyword(s):

Contrast Agent ◽

Digital Subtraction Angiography ◽

Coil Embolization ◽

Endovascular Procedure ◽

Digital Subtraction ◽

Unruptured Aneurysms ◽

Aneurysm Neck ◽

Complete Obliteration ◽

Neck Diameter

IntroductionWe have observed that aneurysms treated by insufficient coil embolization and filled with contrast agent immediately after the procedure are often completely occluded at follow-up. However, there are limited studies showing progressive thrombosis of aneurysms after coil embolization. Herein, we describe our experience with coil embolization for aneurysms, and discuss the factors involved in progressive thrombosis.MethodsA total of 255 aneurysms treated by coil embolization in our institute between January 2011 and June 2017 and observed >6 months were included. ‘Progressive thrombosis’ indicated that aneurysms that were neck remnant (NR) or dome filling (DF) immediately after coil embolization changed to complete obliteration (CO) at the 6-month follow-up digital subtraction angiography. The factors involved in progressive thrombosis were assessed.ResultsIn all aneurysms (n=255), 24 (9.4%) were CO, 82 (32.2%) were NR, and 149 (58.4%) were DF immediately after the procedure. At 6-month digital subtraction angiography, 123 (48.2%) were CO, 95 (37.3%) were NR, and 37 (14.5%) were DF. Retreatment for major recanalization was performed in eight cases (3.1%). One hundred and three aneurysms showed progressive thrombosis. There were significant differences in aneurysm location (P=0.0002), aneurysm dome diameter (P=0.0015), aneurysm neck diameter (P=0.0068), volume embolization ratio (P=0.0054), and endovascular procedure with stent (P=0.0264) between the progressive thrombosis and no thrombosis groups.ConclusionsProgressive thrombosis can occur in aneurysms after coil embolization depending on aneurysm location and size, and stent use. Thus, the degree of coil embolization and combination with a stent should be adjusted depending on aneurysm type.

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