Carotid cavernous fistula associated with persistent primitive trigeminal artery

Area of Science:

• Neuroscience
• Vascular Neurology
• Interventional Neuroradiology

Background:

• Carotid cavernous fistulas (CCFs) are abnormal connections between the carotid artery and the cavernous sinus.
• Persistent primitive trigeminal artery (PPTA) is a rare congenital vascular anomaly representing an early fetal connection between the carotid and vertebrobasilar systems.
• The association between CCF and PPTA is infrequently reported.

Observation:

• A patient presented with diplopia, a common symptom of CCF.
• Angiography revealed a CCF associated with an incidentally discovered PPTA.
• The CCF was successfully treated with balloon occlusion.

Findings:

• Balloon occlusion of the CCF led to flow stasis within the PPTA.
• The patient's diplopia resolved following the intervention.
• This case highlights a potential hemodynamic consequence of CCF treatment on an associated PPTA.

Implications:

• The presence of a PPTA should be considered in patients with CCF, as it may influence treatment strategies.
• Interventional neuroradiologists must be aware of potential PPTA involvement during CCF embolization.
• Understanding this association can improve patient outcomes and prevent treatment-related complications.