Supply from the right meningohypophyseal trunk to the right caroticocavernous fistula with retrograde opacification of the superior orbital vein.
Normal right external carotid artery branches without supply to the caroticocavernous fistula.
Opacification of right cavernous sinus noted, with likely previously partially thrombosed right inferior petrosal sinus and portions of the cavernous sinus. Venous microcatheter injections into the cavernous sinus confirm the caroticocavernous fistula anatomy visualized by right internal carotid artery injections, with eventual microcatheter position wedged into venous side of caroticocavernous fistula. Final images show Onyx cast in an appropriate position within cavernous sinus where the caroticocavernous fistula existed prior to embolization.
Right ICA angiogram after transvenous embolization with Onyx-18 demonstrates no opacification of the cavernous sinus.
CONCLUSION: Right caroticocavernous fistula supplied by the right meningohypophyseal trunk (Barrow type B); successfully embolized transvenously with Onyx-18.