An extracranial carotid artery pseudoaneurysm is a rare condition that is caused by various types of arteritis, trauma and infectious causes. Generally, a pseudoaneurysm may be difficult to treat surgically when dissecting the paraaeurysmal fibrotic dense inflammatory tissues. The surgical management of a peudoaneurysm of the carotid artery involves a risk of nerve and arterial injury. This paper reports the repair of a carotid artery pseudoaneurysm after the proximal and distal control of the internal carotid artery using a Pruitt-Inahara shunt (P-I shunt) and the distal control of the external carotid artery using a small sized occlusion balloon catheter.
Adult ; Carotid-Cavernous Sinus Fistula/*surgery ; Human ; Male ; Vascular Surgical Procedures

Adult ; Basilar Artery ; abnormalities ; Carotid Artery, Internal ; abnormalities ; Carotid-Cavernous Sinus Fistula ; surgery ; Embolization, Therapeutic ; Humans ; Male

Carotid cavernous sinus fistula(CCSF) is an abnormal communication at the base of the skull between the internal carotid artery and the cavernous sinus. Fistula is almost associated with extensive facial trauma as a result of direct or indirect forces. Most fistulas of traumatic origin develop as a result of fractures through the base of the skull, which cause the laceration of the internal carotid artery near the cavernous sinus. The signs and symptoms of CCSF are pulsating exophthalmosis, orbital headache, pain, orbital or frontal bruit, loss of visual acuity, diplopia and ophthalmoplegia. Angiography reveals a definite CCSF and a detachable balloon embolization is known to be the treatment of choice. Even though carotid cavernous sinus fistula is an uncommon complication after orthognathic surgery, several cases of CCSF due to congenital anomalies, pre-existing aneurysms and abnormally thickened maxillary posterior wall have been reported in the literature. We have experienced a case of CCSF after Le Fort I osteotomy for maxillary advancement in skeletal class III patient and the cause, pathogenesis, diagnosis and treatment of this case.]]>
Abducens Nerve Diseases ; Abducens Nerve ; Aneurysm ; Angiography ; Balloon Occlusion ; Carotid Artery, Internal ; Carotid-Cavernous Sinus Fistula ; Cavernous Sinus ; Diagnosis ; Diplopia ; Fistula ; Headache ; Humans ; Lacerations ; Ophthalmoplegia ; Orbit ; Orthognathic Surgery ; Osteotomy ; Skull ; Visual Acuity

In this report, we present a rare case of traumatic carotid cavernous fistula that was occluded during the interventional procedure by incidentally formed blood clot. Sudden occlusion of the fistula and the resolution process of the precarious blood clot can be clearly seen on the serial angiogram.
Vascular Surgical Procedures/*adverse effects ; Treatment Outcome ; Male ; Incidental Findings ; Humans ; Craniocerebral Trauma/*complications ; Carotid-Cavernous Sinus Fistula/etiology/*radiography/*surgery ; Carotid Artery Thrombosis/*etiology/*radiography ; Adult

INTRODUCTIONClinical use of the Amplatzer vascular plug in the cardiopulmonary and peripheral vasculatures has been described extensively in the literature. We present our initial experience in adapting this device for therapeutic sacrifice of major craniocerebral arteries.

MATERIALS AND METHODSBetween July 2007 and November 2008, 8 patients (mean age 59.1 years; range 18 to 82 years) underwent therapeutic occlusion of major craniocerebral arteries using the device, for direct caroticocavernous fistula (1 patient), symptomatic unruptured giant cavernous internal carotid aneurysms (2 patients), and preoperative embolisation before surgical resections of skull base tumours that had encroached upon the internal carotid or vertebral artery (5 patients). The plugs were used alone or in conjunction with detachable platinum coils. The applications of the device, as well as the angiographic and clinical results of the procedures were evaluated.

RESULTSApplications of the plugs were straightforward and successful in all cases, with hermetic occlusions of all target arteries. When used without additional coils, several plugs were deployed in tandem to achieve complete occlusion of the artery. No migration of the device was seen. No patient developed untoward neurological deficits following the procedures, and the 3- and/or 6-month follow-up showed stable results.

CONCLUSIONThe Amplatzer vascular plug could be a valuable addition to the neurointerventional armamentarium, particularly in therapeutic occlusion of major craniocerebral arteries. Rigidity of the delivery system limits its current use to vessels below the skull base. The potential risk of distal thromboembolism also requires further evaluation.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Blood Vessel Prosthesis Implantation ; instrumentation ; methods ; Carotid-Cavernous Sinus Fistula ; Cerebral Angiography ; Cerebrovascular Circulation ; physiology ; Cerebrovascular Disorders ; Female ; Humans ; Intracranial Aneurysm ; surgery ; Male ; Middle Aged ; Outcome Assessment (Health Care) ; Young Adult