Endovascular treatment of trigeminal cavernous fistula: multicentre experience and literature review
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Updated: Sep 14, 2025
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Shin-Nan Lin1, Ho-Fai Wong1, Chung-Wei Lee2
1Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Guishan District, Taoyuan City, 333, Taiwan (R.O.C).
Objectives:
Trigeminal cavernous fistula (TCF) is rare. This study shares treatment experiences and reviews published cases.
Methods:
Between January 1990 and December 2024, 8 consecutive TCF cases from 5 institutes were retrospectively enrolled, along with 38 cases identified via PubMed. Two interventional neuroradiologists independently reviewed and analysed the cases.
Results:
This study enrolled 46 TCF patients, including 26 spontaneous (5 men, 21 women; age range, 22-74 years; mean age, 50.8 years) and 20 traumatic cases (11 men, 8 women, and 1 unknown gender; age range, 16-84 years; mean age, 39.7 years). Persistent primitive trigeminal artery (PPTA) aneurysms were identified in 9 spontaneous (34.6%) and 2 traumatic cases (10.0%). Five cases were treated with combined PPTA aneurysm obliteration and trapping, 5 with PPTA aneurysm obliteration, and 1 with embolization of the cavernous sinus alone; all achieved immediate occlusion without recurrence or permanent complications. Among cases without visible PPTA aneurysms, 4 spontaneous and 5 traumatic cases with type 2 PPTA underwent PPTA trapping, achieving immediate occlusion rates of 100.0% and 80.0%, respectively, and complete occlusion in all cases, with only one recurrence in a traumatic case, without permanent complication. Thirteen spontaneous and 12 traumatic TCF cases with any type PPTA without PPTA aneurysms underwent embolization of the cavernous sinus alone, achieving immediate occlusion rates of 61.5% and 75.0%, complete occlusion in all cases, and comparable recurrence (16.7% and 20.0%) and permanent complication rates (7.7% and 8.3%).
Conclusion:
EVT achieves high occlusion rates with low recurrence and complication rates in TCF cases.
Advances In Knowledge:
In the treatment of TCF associated with PPTA aneurysms, PPTA aneurysm obliteration is essential and most effective. Additionally, PPTA trapping serves as an effective strategy for TCF cases with type 2 PPTA.
