Traumatic Carotid Cavernous Fistula with a Connection between the Supraclinoid Internal Carotid Artery and Cavernous Sinus via a Pseudoaneurysm Presenting with Delayed Life-threatening Epistaxis

Abstract

Purpose: To the best of our knowledge, this is the first case of a traumatic carotid cavernous fistula (CCF) with a connection between the supraclinoid internal carotid artery (ICA) and cavernous sinus (CS) via a pseudoaneurysm, presenting with delayed life-threatening epistaxis. Methods: A patient with a history of basal skull fracture due to blunt head trauma eight months previously was referred to our emergency room for massive epistaxis. Results: Cerebral angiography demonstrated a high-flow CCF with a connection between the supraclinoid portion of left ICA and CS via a pseudoaneurysm, suggesting the lifethreatening epistaxis had been caused by high-flow shunting, through the gap created by the basal skull fracture. Conclusion: After complete obliteration of the pseudoaneurysm arising from the supraclinoid ICA by stent-assisted coil embolization, the CCF was no longer evident and epistaxis ceased.