Carotid-cavernous sinus fistula after external ethmoid-sphenoid surgery. Clinical course and management
R. A. Pedersen, B. T. Troost and V. L. Schramm
The occurrence of a carotid-cavernous sinus fistula following
transethmoidal-sphenoid sinus surgery is unusual. The etiology of this
complication is related to the variations in anatomic position of the
carotid artery and in the thickness of bone overlying the artery in the
lateral sinus wall. In the case reported herein, the clinical course was
complicated by the development of cranial nerve palsies and ocular
ischemia. The patient's symptoms worsened following an attempted to close
the fistula with a microcatheter balloon and isobutyl-cyanoacrylate
embolization. Dramatic improvement in the patient's condition was obtained
by subsequent occlusion of the carotid artery on the side of the fistula
with a microcatheter balloon.