Spontaneous carotid-cavernous fistula during pregnancy or in the postpartum stage

Report of two cases

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✓ The authors report two cases of spontaneous carotid-cavernous fistula that occurred during pregnancy. One patient was a 21-year-old woman whose symptoms improved and in whom disappearance of the carotid-cavernous fistula was confirmed by cerebral angiography after she aborted in the 12th week of pregnancy. The other patient was a 25-year-old woman in whom a carotid-cavernous fistula occurred at about the 28th week of pregnancy. The symptoms became aggravated 3 weeks after a normal delivery. Carotid-cavernous fistula was confirmed by cerebral angiography, and the clinical symptoms then improved. On the basis of cerebral angiographic findings, both patients were considered to have dural arteriovenous fistulas in the region of the cavernous sinus and both demonstrated spontaneous improvement.

Article Information

Address reprint requests to: Shigeo Toya, M.D., Department of Neurosurgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160, Japan.

© AANS, except where prohibited by US copyright law.

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Figures

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    Case 1. Left common carotid angiogram, lateral projection. A: The recurrent meningeal artery (single arrow) which arises from the left ophthalmic artery, and the meningohypophyseal trunk (double arrow), drain into the cavernous sinus (arrowhead). The cavernous sinus drains anteriorly via the superior ophthalmic vein (single crossed arrow) and posteriorly via the superior petrosal sinus (double crossed arrow). B: Angiogram 3 weeks after abortion reveals absence of the fistula.

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    Case 2. Right common carotid angiogram. A: Lateral projection. Early opacification of part of the right cavernous sinus (arrowhead) and of the superior ophthalmic vein (double arrow) is noted. It is difficult to identify the afferent vessels. B: Axial view showing a branch of the middle meningeal artery (single arrow) as the afferent vessel. Venous drainage is via the superior ophthalmic vein.

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    Case 2. Selective right external angiogram, frontal projection. A: Early arterial phase. B: Late arterial phase. Early opacification of the cavernous sinus (arrowhead) and of the superior ophthalmic vein (arrow) is noted.

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