By Dr. Eytan Raz. Trauma.  Delayed CTA for preop evaluation of unrelated surgery.  Do u see the problem?

Angio — direct CC fistula. Amazing demonstration of cavernous sinus compartments.  First, the carotid ruptured into an isolated posterior compartment, connected only to the inferior petrosal sinus.  There must have been other connections — what was connected to it before this rupture? — but they are not visible now.  There is no communication to other compartments — hence no enlargement of SOV, no brain congestion etc. Second — the sylvian veins drain into the laterocavernous sinus — a separate sinus lateral to the cavernous sinus which empties into foramen ovale.  Hence it is unaffected.  Good anatomy huh?  And a lucky break for the patient also, so to speak…

Interesting unrelated variant of MMA frontal branch supply of the anterior (frontal) branch of the Superficial Temporal Artery — rare, and not post-traumatic.  Its important to recognize if you are embolizing the MMA for some reason

Arrows point to the Superficial Temporal Artery branch on the outside view, and the corresponding MMA branch on inside view

Movie below

See Cavernous Sinus Page for more info

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