Fig. 3.

Internal carotid sacrifice for treatment of CC fistula. 4 year-old boy climbed on a shelf which fell on him. He sustained a fracture of the right temporal bone and the left sphenoid squamosal suture. Diagnostic angiography revealed a left CC fistula on AP (A) and lateral (B) imaging. The fistula was initially successfully coiled with minimal residual flow (C and D). However, his ocular presentation persisted and MRI/MRA showed recanalization of the fistula 4 days later. Digital subtraction angiography confirmed recanalization of the fistula with worsened cerebral perfusion from the left ICA (E and F). Because the patient did not show signs of left hemispheric ischemia despite poor flow from the left ICA, the decision was made to embolize the ICA (G). Right internal carotid artery angiography shows collateral perfusion of the left hemisphere and no retrograde filling of the fistula (H). The patient did not develop a left hemispheric stroke and his ocular chemosis resolved. He was discharged to rehabilitation.