Successful closure of trigemino-cavernous fistula with minimally invasive approach

A male in his early teens presented with redness of the right eye following a fall. This redness was progressive and increased suddenly over the week prior to presentation. Fundus evaluation revealed an exudative retinal detachment, and a bruit was audible over the right eye. A digital subtraction angiogram revealed the cause to be a ruptured persistent trigeminal artery aneurysm causing a carotid-cavernous fistula like haemodynamic situation with a massively dilated superior ophthalmic vein. Curative embolisation was done using both vertebrobasilar and carotid approach, and the aneurysm as well as the fistula was occluded using detachable coils and n-butyl cyanoacrylate glue. Patient made a complete recovery in his proptosis and chemosis over 8 weeks, with significant improvement of his visual acuity. The key to successful outcome in this case was a complete occlusion with thrombosis of the fistula bed that can only be achieved using a combination of coils and liquid embolic agents.