Direct Carotid-Cavernous Sinus Fistula (CCF) Due To Spontaneously Ruptured Large Cavernous Sinus Aneurysm-Case Report

Abstract

Purpose: To report a case of acute proptosis and direct carotid-cavernous fistula (CCF) caused by spontaneous rupture of a large cavernous carotid aneurysm Method: Case report. Result: This 61-year-old lady visited our emergent service with the chief complaint of sudden-onset severe headache and right periorbital pain. The systolic blood pressure was 210mmHg, and no trauma history was noted. Ophthalmic examinations revealed swelling of eyelids, proptosis, markedly injected and tortuous conjunctival vessels, extraordinarily high intraocular pressure (IOP), and ophthalmoplegia in the right eye, and these symptoms deteriorated rapidly within hours. Contrast computed topography (CT) angiography and catheter cerebral angiography showed a large cavernous sinus aneurysm with anterior drainage into superior ophthalmic vein and posterior drainage into inferior petrosal sinus in the right side. Under the impression of a ruptured cavernous carotid aneurysm inducing carotid-cavernous sinus fistula (CCF), transarterial embolization of the aneurysm was performed immediately. The IOP returned to normal range on the same day after the procedure, and the other ocular manifestations gradually recovered in the following days without any neurologic sequels. Conclusion: Spontaneous rupture of intracavernous carotid aneurysm, although uncommon, is a possible cause of direct CCF, especially in middleaged or elderly women with systemic hypertension and without history of head trauma.