{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T22:38:07Z","timestamp":1776724687314,"version":"3.51.2"},"reference-count":21,"publisher":"BMJ","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J NeuroIntervent Surg"],"accepted":{"date-parts":[[2009,7,10]]},"published-print":{"date-parts":[[2009,12]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>We present a rare complication of trans-sphenoidal adenectomy (TSA) for pituitary macroadenoma: carotid cavernous fistula (CCF) that was treated with endovascular therapy. The incidence of internal carotid artery (ICA) injury following TSA is 1% and may spontaneously heal by packing and rarely manifest as symptomatic CCF\/aneurysm. Treatment of post-TSA CCF may be challenging due to the breach of nasal floor and may be prone to recurrence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Presentation\/intervention<\/jats:title><jats:p>Uncontrolled intra-operative bleeding during a TSA led to an emergent angiogram to show slow-flow left CCF. Due to clinical deterioration with nasal bleeding, angiography was repeated after 4\u2005h; the fistula had transformed into high flow with significant increase in size, and was therefore embolized using stent-assisted coiling. The fistula recanalized in a month with massive epistaxis and was re-treated using a covered stent graft.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This case represents several unique learning points: (1) CCF as a complication of TSA due to close anatomical proximity; (2) the role of endovascular management post-TSA complication; (3) stent-assisted coil embolization of high-flow fistula with moderate ICA laceration; (4) recanalization of CCF causing massive epistaxis; (5) rare use of covered stent graft stent in distal intracranial circulation maintaining integrity and patency of ICA; (6) long-term results after covered stent graft with no in-stent restenosis.<\/jats:p><\/jats:sec>","DOI":"10.1136\/jnis.2009.001040","type":"journal-article","created":{"date-parts":[[2009,10,31]],"date-time":"2009-10-31T00:35:16Z","timestamp":1256949316000},"page":"142-145","source":"Crossref","is-referenced-by-count":18,"title":["The use of a covered stent graft for obliteration of high-flow carotid cavernous fistula presenting with life-threatening epistaxis"],"prefix":"10.1136","volume":"1","author":[{"given":"J S","family":"Kalia","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T","family":"Niu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"O O","family":"Zaidat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2009,10,30]]},"reference":[{"key":"2024052222401990000_1.2.142.1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.20412"},{"key":"2024052222401990000_1.2.142.2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01401978"},{"key":"2024052222401990000_1.2.142.3","first-page":"610","article-title":"Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings","volume":"33","author":"Knosp","year":"1993","journal-title":"Neurosurgery"},{"key":"2024052222401990000_1.2.142.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.surneu.2005.05.021"},{"key":"2024052222401990000_1.2.142.5","first-page":"306","article-title":"Pituitary tumors: long-term outcomes and expectations","volume":"48","author":"Laws","year":"2001","journal-title":"Clin Neurosurg"},{"key":"2024052222401990000_1.2.142.6","doi-asserted-by":"crossref","first-page":"814","DOI":"10.3171\/jns.1984.61.5.0814","article-title":"A decade of pituitary microsurgery. 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