[A rare complication of septum surgery: internal carotid artery-cavernous sinus fistula]

Perforation, haematoma, a saddle nose, dysaesthesia, liquorrhoea and hyposmia are among the most common complications in septum plasties. A case history points out the danger of a fistula between the sinus cavernosus and the arteria carotis interna during this operation. A patient developed heavy nose bleeding during a septum plasty. A protrusio bulbi, a binocular deterioration in visual acuity, a pulsating tinnitus and a hyperaemic nose appeared postoperatively. By means of angiography of the arteria carotis interna the suspected diagnosis of an AV fistula was confirmed. The fistula was occuled in local anaesthesia by a radiopaque-filled micro-balloon. The possible direct approach using an instrument via the transseptal-transsphenoidal access and the indirect method of injury by breaking out one of the insufficiently mobilised spurs of the lamina perpendicularis and its extension, the dislocated septum interspenoidalis, are described and demonstrated by graphic representations.