This report documents the occurrence, diagnosis and treatment of a 29 year-old male
patient who presented with progressive swelling of the left eye with associated progressive
loss of vision, three months after sustaining a closed head injury in a road traffic
accident. Magnetic resonance imaging (MRI) showed a large, ill-defined lesion in the
left supraclinoid and paraclinoid region with variable contrast enhancement. A four
vessel Digital Subtraction Angiography (DSA) showed a large, supra-clinoid pseudoaneurysm
which had ruptured inferiorly into the roof of cavernous sinus, forming direct carotid
cavernous fistula (CCF) which lead to dilatation of the superior ophthalmic vein and
subsequent peri-orbital oedema and chemosis of conjunctiva. Complete obliteration
of the indirect CCF was achieved by coiling of the aneurysm alone. During follow up,
patient reported a significant improvement in vision and follow up DSA after one year
shows no recurrence with this technique.
Key-words:
Carotid cavernous-fistula - coil embolisation - traumatic cerebral pseudoaneurysm
- supra clinoid
