Published online Dec 28, 2014. doi: 10.4329/wjr.v6.i12.924
Revised: October 4, 2014
Accepted: November 7, 2014
Published online: December 28, 2014
Processing time: 163 Days and 11.5 Hours
Traumatic injuries of the carotid artery may result in severe morbidity and mortality. The most common location of carotid artery injury is the cavernous segment, which may result in fistulous connection to the cavernous sinus and ophthalmic veins, which in turn lead to pressure symptoms in the ipsilateral orbit. Unlike the commonly reported direct traumatic carotid-cavernous fistula, we describe an unusual case of a 38-year-old man presented with a traumatic brain injury led to a fistula connection between the cavernous carotid artery and the ipsilateral basal vein of Rosenthal, with eventual drainage to the straight and transverse sinuses. The basal vein of Rosenthal is usually formed from confluence of anterior and middle cerebral veins deep in the Sylvian fissure and drain the insular cortex and the cerebral peduncles to the vein of Galen. Immediate endovascular deployment of a covered stent in the cavernous carotid artery allowed sealing the laceration site. Three months follow up showed a non-focal neurological examination and healed carotid laceration over the covered stent.
Core tip: Most carotid-cavernous fistulae lead to pressure symptoms in the orbit. This case report suggests alternate routing to the basal vein of Rosenthal, which may convey different implications. Various treatment options used for conventional fistulae; though, in this report we highlight the utility of a covered stent system (Jostent Graftmaster) in the management of carotid-rosenthal fistula.