Spontaneous bilateral carotid cavernous fistula with complete resolution following unilateral embolization:a case report
NIE Yu-jin
WANG Jin-peng
ZHANG Wen-xue
CAO Pei-cheng
Abstract：Carotid cavernous fistulas(CCFs)are predominantly traumatic in clinical practice,while spontaneous bilateral carotid cavernous fistulas are rare.This paper reports a case of spontaneous bilateral CCF in a 64-year-old female who presented with diplopia and pulsatile tinnitus for over six months,accompanied by bilateral exophthalmos(more pronounced in the left eye),limited adduction of the left eyeball,and blowing bruits over both temporal regions.DSA confirmed bilateral dural arteriovenous fistulas in the cavernous sinus region,connected through the intercavernous sinus,classified as Barrow type D.Following preoperative preparation,endovascular embolization of the right cavernous sinus fistula and intercavernous sinus was performed.Postoperative angiography demonstrated complete obliteration of bilateral fistulas.At the 5-month follow-up,the patient exhibited resolution of exophthalmos,conjunctival edema,and cranial bruits,with normal ocular motility,visual acuity,and visual fields.This case highlights that unilateral embolization of bilateral CCFs with intercavernous sinus communication can achieve bilateral fistula closure by altering hemodynamic forces,offering novel insights into the management of complex CCFs.
Keywords：Spontaneous bilateral carotid-cavernous fistulaEndovascular interventional embolizationEfficacy
Publication Date：2025-03-25
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：3( 181-183 )