{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T04:50:16Z","timestamp":1770353416525,"version":"3.49.0"},"reference-count":54,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","license":[{"start":{"date-parts":[[2023,7,31]],"date-time":"2023-07-31T00:00:00Z","timestamp":1690761600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,31]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>\n                      Vascular Ehlers\u2013Danlos syndrome (vEDS) because of\n                      <jats:italic>COL3A1<\/jats:italic>\n                      mutations is a rare inherited collagen vascular disease associated with spontaneous arterial dissections, aneurysms, vessel rupture, and organ rupture. A direct carotid-cavernous fistula (CCF) is the most common central nervous system vascular anomaly in vEDS; however, its treatment is challenging due to extremely fragile arteries and veins.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 22-year-old woman presented with pulsatile tinnitus and mild diplopia. CCF formation without trauma, cervical dissecting aneurysms, thin skin, and multiple ligament tears, as well as a genetic analysis, led to a diagnosis of vEDS. To minimize the risk of vascular injury in the thoracoperitoneal cavity, the internal jugular vein was directly punctured and the CCF was embolized transvenously using the triple-overlay road-mapping technique without arterial monitoring. The CCF was completely occluded, and the patient showed an excellent clinical course without neurological or vascular complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Physicians and neurosurgeons should consider vEDS when treating younger patients with spontaneous CCF without trauma and investigate the possibility of genetic abnormalities and systemic vascular pathology. Transvenous embolization of a CCF through the transjugular route using the triple-overlay road-mapping technique can minimize the risk of vascular injury in a patient with vEDS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case23188","type":"journal-article","created":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T09:24:26Z","timestamp":1690881866000},"source":"Crossref","is-referenced-by-count":4,"title":["Percutaneous transjugular approach without arterial monitoring for the treatment of a direct carotid-cavernous fistula with vascular Ehlers\u2013Danlos syndrome: illustrative case"],"prefix":"10.3171","volume":"6","author":[{"given":"Naoyuki","family":"Uchiyama","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yosuke","family":"Kawahara","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wataru","family":"Uchida","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayumu","family":"Nitta","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsushi","family":"Nohara","sequence":"additional","affiliation":[{"name":"Department of Clinical Genetics, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yutaka","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"J Neurosurg","first-page":"248","article-title":"Classification and treatment of spontaneous carotid-cavernous sinus fistulas","volume":"62","author":"Barrow DL","year":"1985","unstructured":"Barrow DL, Spector RH, Braun IF, Landman JA, Tindall SC, Tindall GT. 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