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Appearance of middle meningeal artery fistulae after Willis covered stent for traumatic carotid cavernous fistulae: two case reports

Author(s):

Ting Wang, Seidu A. Richard, Changwei Zhang*, Xiaodong Xie and Chaohua Wang  

Abstract:


Introduction: Carotid cavernous fistulae (CCF) are rare and they occur when there is a communication between the internal carotid artery (ICA) and cavernous sinus. These lesions are associated with blunt or penetrating traumatic injuries of the carotid arteries. We present the first cases of cavernous dural arteriovenous fistulae (cDAVF) in the middle meningeal artery (MMA) after the treatment of direct CCF in the ICA with Willis covered stents (WCSs).

Case Presentations: Our patients comprised of 22 and 50-year-old males with histories of head injuries months before admission at our facility. In both patients above, cerebral angiography revealed fistulae in right ICA and Left ICA respectively. They were treated with WCSs via the trans-artery endovascular route. In both cases the treatments were not in way attempted via the MMA. Subsequently, they developed cDAVF in the middle meningeal artery (MMA) which were treated with Onyx Liquid Embolic System (Onyx HD-500) (Covidien / ev3 Neurovascular) and conservatively respectively.

Conclusion: These are the first cases in whom WCSs for the management of direct CCF resulted in cDAVF at the MMA. The WCSs inside the ICA could have resulted into the cDAVF via unknown mechanisms but not iatrogenic.

Keywords:

CCF, cDAVF, endovascular, ICA, WCS, Onyx.

Affiliation:

Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang Street, Chengdu, 610041, Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang Street, Chengdu, 610041, Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang Street, Chengdu, 610041, Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang Street, Chengdu, 610041, Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang Street, Chengdu, 610041



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