{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T17:10:04Z","timestamp":1775841004930,"version":"3.50.1"},"reference-count":10,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2017,7,20]]},"abstract":"<jats:p>Endovascular embolization is the standard approach for management of carotid cavernous fistulas (CCFs) due to the ease of access and reduced level of risk associated with the procedure compared with open surgery. We present here a case of a CCF that eventually led to the development of brainstem venous congestion from perimedullary venous drainage. This fistula was not amenable to endovascular embolization due to lack of either ophthalmic vein or petrosal sinus drainage. Therefore, a craniotomy with direct puncture of the cavernous sinus was performed, followed by coil embolization to completely treat this fistula. This case demonstrates an uncommon progression of venous drainage to Cognard grade V, rare development of symptomatic brainstem venous congestion and a unique method to combine an open surgical approach with endovascular embolization to treat CCFs.<\/jats:p>","DOI":"10.1136\/bcr-2017-013248","type":"journal-article","created":{"date-parts":[[2017,8,28]],"date-time":"2017-08-28T14:35:15Z","timestamp":1503930915000},"page":"bcr-2017-013248","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Combined surgical and endovascular approach to treat a carotid cavernous fistula with associated brainstem venous congestion"],"prefix":"10.1136","volume":"2017","author":[{"given":"Sandeep","family":"Muram","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Javed","family":"Khader Eliyas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muneer","family":"Eesa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alim P","family":"Mitha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,8,28]]},"reference":[{"key":"2025042712345098000_2017.aug28_1.bcr-2017-013248.1","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2011-010209"},{"key":"2025042712345098000_2017.aug28_1.bcr-2017-013248.2","first-page":"1","article-title":"Diagnosis and management of dural carotid-cavernous sinus fistulas","volume":"23","author":"Miller","year":"2007","journal-title":"Neurosurg Focus"},{"key":"2025042712345098000_2017.aug28_1.bcr-2017-013248.3","doi-asserted-by":"crossref","first-page":"53","DOI":"10.4103\/2152-7806.96076","article-title":"Pontine venous congestion due to dural arteriovenous fistula of the cavernous sinus: case report and review of the literature","volume":"3","author":"Miyagishima","year":"2012","journal-title":"Surg Neurol Int"},{"key":"2025042712345098000_2017.aug28_1.bcr-2017-013248.4","doi-asserted-by":"crossref","unstructured":"Trivelato FP , Manzato LB , Filho PM , et al . 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A case report","volume":"8","author":"Naito","year":"2002","journal-title":"Interv Neuroradiol"},{"key":"2025042712345098000_2017.aug28_1.bcr-2017-013248.7","doi-asserted-by":"publisher","DOI":"10.1177\/159101991201800412"},{"key":"2025042712345098000_2017.aug28_1.bcr-2017-013248.8","first-page":"1","article-title":"Endoscope-assisted transsphenoidal puncture of the cavernous sinus for embolization of carotid-cavernous fistula in a neurosurgical hybrid operating suite","volume":"5","author":"Tang","year":"2016","journal-title":"J Neurosurg"},{"key":"2025042712345098000_2017.aug28_1.bcr-2017-013248.9","first-page":"ons E343","article-title":"Transcortical venous approach for direct embolization of a cavernous sinus dural arteriovenous fistula: technical case report","volume":"70","author":"Chaudhary","year":"2012","journal-title":"Neurosurgery"},{"key":"2025042712345098000_2017.aug28_1.bcr-2017-013248.10","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2011-010227"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2017-013248","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T19:34:59Z","timestamp":1745782499000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2017-013248"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,8,28]]},"references-count":10,"alternative-id":["10.1136\/bcr-2017-013248"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2017-013248","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,8,28]]}}}