Indirect caroticocavernous fistula

Case contributed by Frank Gaillard
Diagnosis certain

Patient Data

Gender: Male

The right superior ophthalmic vein is markedly distended and the cavernous sinus plump. 

A dural arteriovenous fistula of the right cavernous sinus is seen (indirect caroticocavernous fistula) supplied mainly by multiple branches of the right internal maxillary artery, including several branches arising from the middle meningeal artery, the accessory meningeal artery, and the artery of the foramen rotundum. There is additional supply to the fistula in the right cavernous sinus arising from the meningohypophyseal branches of the internal carotid arteries bilaterally.

The right-sided fistula drains to the right SOV directly, and to the left SOV via a trans-sellar anastomosis. The inferior petrosal sinuses are thrombosed bilaterally.

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