Cavernous arteriovenous fistula after the removal of carotid body tumor

Abstract

A 48-year-old woman presented with an enlarged mass at the left angle of the mandible, which was confirmed by biopsy specimen as carotid body tumor. A contrast computed tomography scan demonstrated that the tumor enclosed the bifurcation of the common carotid artery (CCA) and the beginning segment of the internal carotid artery (ICA, A). The entire tumor and the adjacent arterial segments were surgically removed, and a shunt was placed between the opening ends of the CCA and ICA to maintain the blood supply to the ipsilateral cerebral hemisphere. Interruption of blood flow during the shunt placement was 5 minutes. An end-to-end anastomosis between the CCA and ICA was accomplished with a 6-mm-diameter artificial vascular graft. Decreased motion in the right limbs was noted as the patient awoke from the general anesthesia. On postoperative day 2, she was fully awake but unable to speak. Fine movement of the right hand was markedly impaired, and a progressive swelling of the left eye was observed. On the following day, an abnormal puffing noise was heard in the patient’s left temple. Magnetic resonance imaging demonstrated extensive ischemic changes in the left cerebral hemisphere (B). Digital subtraction angiography showed both cavernous sinuses were enlarged due to a cavernous arteriovenous fistula (C and D). The fistula was successfully corrected 2 months later with coil and glue embolization administered through the left jugular vein. The patient recovered well at 6-month follow-up.