Giant Carotid-Cavernous Fistula with Complete Shunt

Patient is a 37-year-old male with a history of head trauma surgery 8 years ago, admitted for persistent pulsatile exophthalmos and intracranial murmur. Angiography results showed: blood from the right internal carotid artery(RICA) flowed directly into the cavernous sinus(CS), with the arterial system above the CS not visualized; early visualization of the right venous sinus system; dilation of the right superior ophthalmic vein(SOV) and the medial canthal vein. Bilateral anterior and middle cerebral arteries were perfused through the left internal carotid artery(LICA). We diagnosed a right-sided carotid cavernous fistula(CCF). After a comprehensive preoperative assessment, we chose spring coil embolization treatment, which resulted in the disappearance of symptoms post-treatment. Three month later, upon follow-up, the patient reported no longer hearing intracranial murmur, and auscultation of the right temporal region revealed no abnormal sounds.