Direct arteriovenous fistula at the inferolateral trunk mimicking carotid cavernous fistula without involving the cavernous sinus: a case report

• Published in: Acta neurochirurgica 2012-03, Vol.154 (3), p.465-469
• Main Authors: Horie, Nobutaka, Morikawa, Minoru, So, Gohei, Hayashi, Kentaro, Suyama, Kazuhiko, Nagata, Izumi
• Format: Article
• Language: English
• Subjects: Aged; Arteriovenous Fistula - diagnostic imaging; Arteriovenous Fistula - pathology; Arteriovenous Fistula - therapy; Carotid Artery Diseases - diagnostic imaging; Carotid Artery Diseases - pathology; Carotid Artery Diseases - therapy; Carotid Artery Injuries - diagnostic imaging; Carotid Artery Injuries - pathology; Carotid Artery Injuries - therapy; Carotid Artery, Internal - diagnostic imaging; Carotid Artery, Internal - pathology; Case Report; Case reports; Cavernous Sinus Thrombosis - diagnostic imaging; Cavernous Sinus Thrombosis - pathology; Diagnosis, Differential; Female; Head; Humans; Injuries; Interventional Radiology; Medicine; Medicine & Public Health; Mimicry; Minimally Invasive Surgery; Neurology; Neuroradiology; Neurosurgery; Radiography; Retinal Vein - diagnostic imaging; Retinal Vein - pathology; Sinus; Surgical Orthopedics; Veins
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-011-1226-8

The authors present the case of a 66-year-old female who developed progressive pulsating exophthalmos, a bruit, and conjunctival chemosis 7 months after a head injury. These symptoms, though highly suspicious of carotid cavernous fistula, were caused by an arteriovenous fistula (AVF) between the inferolateral trunk (ILT) and the ophthalmic veins. A direct AVF at the branch of the ILT without involvement of the cavernous sinus is extremely rare, but could occur in the case of acquired AVF since the ILT has some branches around venous structures outside the cavernous sinus. The clinical implications of this case are discussed in terms of the anatomical aspects.