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<p>An arteriovenous shunt involving the cavernous sinus can be a direct carotid-cavernous fistula (CCF; in which the internal carotid artery communicates with the cavernous sinus) or a cavernous sinus dural arteriovenous fistula (CS-dAVF; in which the blood drains via a dural internal carotid artery branch and/or a dural external carotid artery branch). This represents a communication between an artery and a vein that bypasses the capillary network. Arteriovenous shunts involving the cavernous sinus usually occur due to trauma, but on rare occasions they may arise spontaneously, for example due to a ruptured aneurysm. We present the case of a 72-year-old woman admitted to our department with binocular horizontal diplopia when moving her eyes to the right, mild right eyelid ptosis, and redness of the right eye along with hypertensive spikes, occasional headaches, and tinnitus. These symptoms had a sudden onset and persisted for approximately 1.5 months. Digital subtraction angiography revealed a spontaneous direct communication between a large aneurysm of the left internal carotid artery and the contralateral cavernous sinus through the intercavernous sinus. Thus, the symptoms appeared contralateral to the ruptured aneurysm. The following day, she underwent endovascular embolization of this fistula, and subsequently her symptoms subsided. In conclusion, this is a particularly rare case of a spontaneous CCF that presented with contralateral ocular symptoms. Endovascular embolization can be effective in occluding spontaneous direct carotid-cavernous fistulas and in treating the underlying symptoms that can present due to this abnormal communication.</p>

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Spontaneous direct carotid cavernous fistula caused by ruptured internal carotid artery aneurysm presenting with contralateral ocular symptoms

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月6日

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  • Marianna E. Kapsetaki,
  • Konstantinos Ntotsikas,
  • Konstantinos Vagias,
  • Christopher Susanto,
  • Sofia Lazarioti,
  • Athanasios Theofanopoulos,
  • Nikolaos Moustakis,
  • Andronikos Trikkos,
  • Elias Kehagias,
  • Nikolaos Nasis,
  • Christos Tsitsipanis

摘要

An arteriovenous shunt involving the cavernous sinus can be a direct carotid-cavernous fistula (CCF; in which the internal carotid artery communicates with the cavernous sinus) or a cavernous sinus dural arteriovenous fistula (CS-dAVF; in which the blood drains via a dural internal carotid artery branch and/or a dural external carotid artery branch). This represents a communication between an artery and a vein that bypasses the capillary network. Arteriovenous shunts involving the cavernous sinus usually occur due to trauma, but on rare occasions they may arise spontaneously, for example due to a ruptured aneurysm. We present the case of a 72-year-old woman admitted to our department with binocular horizontal diplopia when moving her eyes to the right, mild right eyelid ptosis, and redness of the right eye along with hypertensive spikes, occasional headaches, and tinnitus. These symptoms had a sudden onset and persisted for approximately 1.5 months. Digital subtraction angiography revealed a spontaneous direct communication between a large aneurysm of the left internal carotid artery and the contralateral cavernous sinus through the intercavernous sinus. Thus, the symptoms appeared contralateral to the ruptured aneurysm. The following day, she underwent endovascular embolization of this fistula, and subsequently her symptoms subsided. In conclusion, this is a particularly rare case of a spontaneous CCF that presented with contralateral ocular symptoms. Endovascular embolization can be effective in occluding spontaneous direct carotid-cavernous fistulas and in treating the underlying symptoms that can present due to this abnormal communication.