Carotid-cavernous Fistula Associated with a Ruptured Persistent Primitive Trigeminal Artery Aneurysm: A Case Report and Review of Literature

Carotid-cavernous sinus fistula (CCF) caused by a ruptured aneurysm of the persistent primitive trigeminal artery (PPTA) is rarely reported. A 69-year-old woman presented with progressive ptosis and pulsating tinnitus. Vertebral angiography under flow control of the internal carotid artery revealed CCF associated with a ruptured PPTA-trunk aneurysm, and PPTA was divided into Saltzman type 2. Endovascular treatment was performed by coil embolization of the aneurysm and parent artery occlusion of the PPTA, preserving the basilar artery (BA) side of PPTA, without complications. In the case of ruptured aneurysms originating from the Saltzman type 2 PPTA trunk, parent artery occlusion of the PPTA might be a treatment option and preservation of the BA side of PPTA is necessary to avoid ischemic complication of pons.