Ocular needlefish injury with cavernous sinus thrombosis and carotid-cavernous fistula: illustrative case

Anahita Malvea; Armaan K Malhotra; Ann Schmitz; Whitney Parker; Leeor Yefet; Prakash Muthusami; James T Rutka; Peter Dirks

doi:10.3171/CASE22477

Ocular needlefish injury with cavernous sinus thrombosis and carotid-cavernous fistula: illustrative case

J Neurosurg Case Lessons. 2023 May 1;5(18):CASE22477. doi: 10.3171/CASE22477. Print 2023 May 1.

Authors

Anahita Malvea¹, Armaan K Malhotra¹, Ann Schmitz², Whitney Parker², Leeor Yefet¹, Prakash Muthusami³, James T Rutka², Peter Dirks²

Affiliations

¹ 1Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; and.
² 2Department of Surgery, Division of Neurosurgery, and.
³ 3Department of Medical Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada.

Abstract

Background: The Belonidae family of fish has been implicated in various penetrating injuries; to date, however, there have been limited reports of brain injury due to this species.

Observations: The authors present the case of a young patient who suffered an ocular penetrating injury from a needlefish with a resultant cavernous sinus thrombosis and concomitant carotid-cavernous fistula. This case highlights the interdisciplinary management of this rare condition through a strategy of anticoagulation titration to the endpoint of fistula closure.

Lessons: Through this report the importance of a high index of suspicion for neurovascular injury and fistula formation in penetrating ocular injuries is highlighted as well as the importance of interdisciplinary management of patients with such injuries and their sequelae.

Keywords: CCF = carotid-cavernous fistula; CST = cavernous sinus thrombosis; CT = computed tomography; ICA = internal carotid artery; MRA = magnetic resonance angiography; MRI = magnetic resonance imaging; carotid-cavernous fistula; cavernous sinus thrombosis; needlefish; ocular injury.