Direct carotid cavernous fistula after trigeminal balloon microcompression gangliolysis: Case report

OBJECTIVE AND IMPORTANCE: Percutaneous gangliolysis procedures may rarely be associated with vascular complications. There are three reported cases of carotid cavernous fistulas occurring after percutaneous retrogasserian procedures. We present one case of acute symptomatic direct carotid cavernous fistula after percutaneous balloon microcompressive trigeminal gangliolysis. This is the only reported case of this complication associated with microcompression gangliolysis. CLINICAL PRESENTATION: A 78- year-old woman was referred to our institution with a history of abrupt onset of left-sided bruit, proptosis, chemosis, and diplopia after a percutaneous retrogasserian microcompression. INTERVENTION: Cerebral angiography revealed a large left direct carotid cavernous fistula. Attempts at balloon embolization were unsuccessful, and the lesion was ultimately cured by transarterial and transvenous coil embolization. CONCLUSION: Follow-up examination revealed no evidence of bruit or neurological deficit. This report highlights a unique complication of balloon gangliolysis and describes coil embolization of the fistula as the mode of treatment.