Work

A Case of Cavernous Sinus Fistula Caused by Ruptured Spontaneous Aneurysm on Persistent Primitive Trigeminal Artery

Year: 2024

Type: article

Abstract: The most frequent of the embryonic persistent arteries that connect the internal carotid artery to the posterior circulation is the persistent primitive trigeminal artery (PPTA), which is recognized on 0.1%-0.6% on the basis of conventional angiography or magnetic resonance imaging (MRI). It is usually asymptomatic; however, in rare cases, symptoms of cerebral neuropathy or vascular disease may take place. The patient was a 50-year-old woman who had a history of dyslipidemia and no history of trauma. After a visit to her local doctor, she was referred to us with complaints of mild headache and unilateral tinnitus. MRI revealed a cavernous sinus fistula. She had temporary symptom relief, but ipsilateral ocular symptoms appeared eventually and extended to the contralateral side. Through cerebral angiography, a direct cavernous sinus fistula due to a ruptured PPTA trunk aneurysm was revealed. Coil embolization was carried out via PPTA. The PPTA aneurysm was partially embolized from within the venous sinus using a fistula. The aneurysm and cavernous sinus fistula disappeared without transvenous embolization while preserving the PPTA. Although reports on the treatment of PPTA aneurysms have been numerous already, this report describes a unique case in which a ruptured spontaneous aneurysm on the PPTA trunk resulted in a cavernous sinus fistula, which was treated successfully.

Source: NMC Case Report Journal

DOI: 10.2176/jns-nmc.2024-0151