Giant Carotid-Cavernous Fistula with Complete Shunt

A 37-year-old man with a history of head trauma surgery 8 years previously was admitted because of persistent pulsatile exophthalmos and intracranial murmur. Angiography results showed that blood from the right internal carotid artery flowed directly into the cavernous sinus , with the arterial system above the cavernous sinus not visualized; early visualization of the right venous sinus system; dilation of the right superior ophthalmic vein and the medial canthal vein. Bilateral anterior and middle cerebral arteries were perfused through the left internal carotid artery. We diagnosed a right-sided carotid-cavernous fistula. After a comprehensive preoperative assessment, we chose spring coil embolization treatment, which resulted in the disappearance of symptoms after treatment. Three months later, on follow-up, the patient reported no longer hearing intracranial murmur, and auscultation of the right temporal region showed no abnormal sounds.