A Case of the Carotid-Cavernous Fistula Due to the Internal Carotid Artery Injury During Endoscopic Sinus Surgery

Jae Ki Kim; Seong Kyeong Yang; Dan Bi Shin; Jung Gwon Nam

doi:10.18787/jr.2015.22.2.116

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Kim, Yang, Shin, and Nam: A Case of the Carotid-Cavernous Fistula Due to the Internal Carotid Artery Injury During Endoscopic Sinus Surgery

Case Report

J Rhinol 2015;22(2):116-120.

Published online: 10 January 2015

DOI: https://doi.org/10.18787/jr.2015.22.2.116

A Case of the Carotid-Cavernous Fistula Due to the Internal Carotid Artery Injury During Endoscopic Sinus Surgery

Jae Ki Kim, MD, Seong Kyeong Yang, MD, Dan Bi Shin, MD, Jung Gwon Nam, PhD

Department of Otolaryngology-Head and Neck Surgery, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea

교신저자：남정권, 44033 울산광역시 동구 방어진순환도로 877 울산대학교 의과대학 울산대학교병원 이비인후과학교실 Tel: +82-52-250-7180, Fax: +82-52-234-7182, E-mail: jknam0266@naver.com

Received 15 January 2015 Revised 28 March 2015 Accepted 26 August 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Rupture of the internal carotid artery (ICA) during endoscopic sinus surgery is a rare complication. However, it can potentially result in death within minutes. In the event of a traumatic injury to the ICA during sphenoid sinus exploration, it is very difficult to control the bleeding. We present a case of carotid-cavernous fistula after an accidentally-developed ICA bleed during endoscopic sphenoidotomy. The patient was successfully treated with endovascular embolization techniques that included detachable microcoils.

Keywords: Internal carotid artery, Carotid-cavernous sinus fistula.

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Fig. 1.

(A) Coronal CT scan of the paranasal sinues shows the right sphenoid sinus is less developed (arrow) than the left sphenoid sinus. (B) Coronal CT scan is more posterior section than. The right internal carotid artery (arrow head) is deviated to the medial side due to the less developed right spenoid sinus.

Fig. 2.

The right internal carotid angiography (lateral view) shows irregular narrowing of the supraclinoid segment of the right ICA (arrow) due to probably vasospasm after ICA injury. However, active bleeding is not observed. ICA: internal carotid artery.

Fig. 3.

Transfemoral carotid angiography (lateral view) shows the early filling of cavernous sinus (arrow) and the venous drainage into the superior ophthalmic vein (arrow head) due to ca-rotid-cavernous fistula.

Fig. 4.

Right internal carotid 3D angiography after endovascular coil embolization shows the coil placed in the carotid-cavern-ous fistula (arrow).

Fig. 5.

Post-endovascular coil embolization brain MRI. There are no evidence of hemorrhage and neurologic deficit in the brain parenchyma. A: Axial T1 weighted image. B: Axial T2 weighted image, there is an artifact in the right cavernous sinus due to endovascular coils (arrow).

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