CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(01): 184-190
DOI: 10.1055/s-0043-1761239
Case Report

Traumatic Supraclinoid Internal Carotid Artery Pseudoaneurysm associated with Carotid-Cavernous Fistula and Contralateral Anterior Cerebral Artery Pseudoaneurysm Treated by Surgical Trapping with High-Flow Bypass and A3-A3 Bypass: A Case Report and Literature Review

1   Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
Sasikan Sukhor
1   Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
Thanapum Kaewprasert
1   Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
1   Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
› Author Affiliations


Traumatic pseudoaneurysms of the supraclinoid internal carotid artery (ICA) are uncommon, particularly associated with carotid-cavernous fistulas (CCF) or multiple traumatic aneurysms. This report describes a patient with a ruptured left ICA dissecting pseudoaneurysm that caused a direct CCF and a right anterior cerebral artery (ACA) pseudoaneurysm. To eliminate the aneurysm and fistula, we followed the universal bypass strategy by performing an ICA trapping with high-flow bypass, followed by an ACA trapping with A3-A3 side-to-side bypass. Herein, we report the first successful surgical trapping and revascularization of supraclinoid ICA pseudoaneurysm associated with a direct carotid-cavernous fistula.

Publication History

Article published online:
29 March 2023

© 2023. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

  • References

  • 1 Benoit BG, Wortzman G. Traumatic cerebral aneurysms. Clinical features and natural history. J Neurol Neurosurg Psychiatry 1973; 36 (01) 127-138 DOI: 10.1136/jnnp.36.1.127.
  • 2 Reddy SV, Sundt Jr TM. Giant traumatic false aneurysm of the internal carotid artery associated with a carotid-cavernous fistula. Case report. J Neurosurg 1981; 55 (05) 813-818 DOI: 10.3171/jns.1981.55.5.0813.
  • 3 Masana Y, Taneda M. Direct approach to a traumatic giant internal carotid artery aneurysm associated with a carotid-cavernous fistula. Case report. J Neurosurg 1992; 76 (03) 524-527 DOI: 10.3171/jns.1992.76.3.0524.
  • 4 Tytle TL, Loeffler CL, Steinberg TA. Fistula between a posterior communicating artery aneurysm and the cavernous sinus. Am J Neuroradiol 1995; 16 (09) 1808-1810
  • 5 Fu Y, Ohata K, Tsuyuguchi N, Hara M. Direct surgery for posttraumatic carotid-cavernous fistula as a result of an intradural pseudoaneurysm: case report. Neurosurgery 2002; 51 (04) 1071-1073 , discussion 1073–1074 DOI: 10.1097/00006123-200210000-00040.
  • 6 Komiyama M, Yasui T, Yagura H, Fu Y, Nagata Y. Traumatic carotid-cavernous sinus fistula associated with an intradural pseudoaneurysm: a case report. Surg Neurol 1991; 36 (02) 126-132 DOI: 10.1016/0090-3019(91)90230-7.
  • 7 Kinugasa K, Higashi H, Ohmoto T. Fistula of the posterior communicating artery and cavernous sinus. Am J Neuroradiol 1995; 16 (08) 1626-1628
  • 8 Weaver KD, Ewend MG, Solander S. Successful transarterial Guglielmi detachable coil embolization of posttraumatic posterior communicating artery-cavernous sinus fistula: technical note. Neurosurgery 2003; 52 (02) 458-460 , discussion 460–461 DOI: 10.1227/01.neu.0000043817.55770.f8.
  • 9 Lee CY, Yim MB, Kim IM, Son EI, Kim DW. Traumatic aneurysm of the supraclinoid internal carotid artery and an associated carotid-cavernous fistula: vascular reconstruction performed using intravascular implantation of stents and coils. Case report. J Neurosurg 2004; 100 (01) 115-119 DOI: 10.3171/jns.2004.100.1.0115.
  • 10 Oran I, Parildar M, Memis A, Dalbasti T. Posttraumatic intradural internal carotid artery-cavernous sinus fistula associated with ipsilateral carotid dissection. Transarterial embolization with detachable coils. Interv Neuroradiol 2004; 10 (01) 63-68 DOI: 10.1177/159101990401000108.
  • 11 Cho JH, Jung C, Sheen SH, Kwon BJ, Han MH. Traumatic carotid cavernous fistula caused by intradural aneurysm rupture: a case report. Neurointervention 2006; 1 (01) 39-43
  • 12 Zhao P, Liu L, Jiang C, Jiang P, Yang X. Coils and onyx embolization of traumatic carotid-cavernous fistula caused by an intradural internal carotid artery pseudoaneurysm. Neuroradiol J 2012; 25 (02) 231-236 DOI: 10.1177/197140091202500214.
  • 13 Karanam LS, Alurkar AB, Natarajan M, Pugazhenthi B. Endovascular coil occlusion of traumatic intradural aneurysm with presentation as carotid cavernous fistula. J Clin Imaging Sci 2014; 4: 11 DOI: 10.4103/2156-7514.127961.
  • 14 Narayan DN, Jayprakash SV, Arjun D, Achal G. Coil embolisation of post traumatic giant supraclinoid pseudoaneurysm presenting as carotid cavernous fistula. Asian J Neurosurg 2018; 13 (04) 1244-1246 DOI: 10.4103/ajns.AJNS_161_17.
  • 15 Lewis AI, Tomsick TA, Tew Jr JM. Management of 100 consecutive direct carotid-cavernous fistulas: results of treatment with detachable balloons. Neurosurgery 1995; 36 (02) 239-244 , discussion 244–245 DOI: 10.1227/00006123-199502000-00001.
  • 16 Gomez F, Escobar W, Gomez AM, Gomez JF, Anaya CA. Treatment of carotid cavernous fistulas using covered stents: midterm results in seven patients. AJNR Am J Neuroradiol 2007; 28 (09) 1762-1768 DOI: 10.3174/ajnr.A0636.
  • 17 Lee CH, Luo CB. Pseudoaneurysm of the basilar artery presenting with epistaxis. Br J Neurosurg 2020; 34 (05) 475-476 DOI: 10.1080/02688697.2018.1445197.
  • 18 Amenta PS, Starke RM, Jabbour PM. et al. Successful treatment of a traumatic carotid pseudoaneurysm with the pipeline stent: case report and review of the literature. Surg Neurol Int 2012; 3: 160 DOI: 10.4103/2152-7806.105099.
  • 19 Mizunari T, Murai Y, Kim K, Kobayashi S, Kamiyama H, Teramoto A. Posttraumatic carotid-cavernous fistulae treated by internal carotid artery trapping and high-flow bypass using a radial artery graft–two case reports. Neurol Med Chir (Tokyo) 2011; 51 (02) 113-116 DOI: 10.2176/nmc.51.113.
  • 20 Ryu J, Chang S, Choi SK, Lee SH, Chung Y. Radial artery graft bypass with endovascular trapping of the internal carotid artery for recurrent carotid cavernous fistula: different surgical fields, different surgical considerations. World Neurosurg 2017; 98: 884.e7-884.e12 DOI: 10.1016/j.wneu.2016.06.091.