Carotid-cavernous fistula following percutaneous retrogasserian procedures. Report of two cases

Carotid arterial puncture during percutaneous retrogasserian procedures is a common but usually harmless complication. Strokes, resulting presumably from carotid artery thrombosis, have been reported previously following percutaneous retrogasserian coagulation. The authors report two cases of carotid-cavernous fistula, one following percutaneous radiofrequency rhizotomy and the other after percutaneous retrogasserian block. The latter patient had an anomalous primitive foramen lacerum. Both fistulas were obliterated successfully by intracavernous injection of isobutyl-2 cyanoacrylate, using intra-arterial balloon flotation catheters. Carotid-cavernous fistula is a potentially serious complication of such procedures, and may be more common than realized since small fistulas may close spontaneously.