{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T15:12:18Z","timestamp":1781968338340,"version":"3.54.5"},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,8,4]]},"abstract":"\n BACKGROUND<\/jats:title>\n Thirteen cases of fungal cavernous-carotid aneurysms (CCAs) attributable to invasive fungal sinusitis have been reported in the literature. These reports included only 1 case of carotid-cavernous fistula (CCF). In this report, the authors present a case of CCF attributable to the rupture of an infected CCA caused by invasive fungal sinusitis that required proximal occlusion for treatment.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 56-year-old man with poorly controlled diabetes experienced a sudden loss of vision in his left eye. Cranial imaging revealed invasive sphenoid sinusitis and CCF attributable to a ruptured infected CCA, as well as an unruptured infected supraclinoid internal carotid artery (ICA) aneurysm. After 3 weeks of medical treatment, the patient developed sudden impairment of higher function. MRI revealed occlusion of the distal ICA attributable to thrombosis of the supraclinoid ICA aneurysm. The anterior circulation was perfused from the contralateral side via the anterior communicating artery. Proximal occlusion with coils was performed, leading to ablation of the CCF.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n This is the first reported case of spontaneous thrombosis of an infected distal cerebral aneurysm, and proximal occlusion with coils was necessary to treat CCF caused by the rupture of a fungal CCA. This case could help guide future treatment.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25336<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25336","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T06:35:52Z","timestamp":1754289352000},"source":"Crossref","is-referenced-by-count":1,"title":["Proximal occlusion for infectious carotid-cavernous fistula caused by invasive fungal sinusitis: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-9993-1685","authenticated-orcid":true,"given":"Akihiro","family":"Okada","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Osaka Red Cross Hospital, Osaka, Osaka, Japan"},{"name":"Department of Neurosurgery, Eisyokai Yoshida Hospital, Kobe, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeshi","family":"Kawauchi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Osaka Red Cross Hospital, Osaka, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukinori","family":"Terada","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Osaka Red Cross Hospital, Osaka, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Hashimoto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Osaka Red Cross Hospital, Osaka, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"10","key":"bib1","series-title":"J Fla Med Assoc","first-page":"863","article-title":"Mucormycosis associated with carotid cavernous fistula and cavernous carotid mycotic aneurysm","volume":"76","author":"Saff","year":"1989","unstructured":"Saff GFrau MMurtagh FRSilbiger ML.Mucormycosis associated with carotid cavernous fistula and cavernous carotid mycotic aneurysm. J Fla Med Assoc. 1989;76(10):863-865."},{"issue":"5-6","key":"bib2","series-title":"Mycopathologia","first-page":"425","article-title":"Fungal mycotic aneurysm of the internal carotid artery associated with sphenoid sinusitis in an immunocompromised patient: a case report and review of the literature","volume":"181","author":"Azar","year":"2016","unstructured":"Azar MMAssi RPatel NMalinis MF.Fungal mycotic aneurysm of the internal carotid artery associated with sphenoid sinusitis in an immunocompromised patient: a case report and review of the literature. Mycopathologia. 2016;181(5-6):425-433."},{"issue":"10","key":"bib3","series-title":"Clin Neurol Neurosurg","first-page":"1927","article-title":"Intracavernous internal carotid artery mycotic aneurysms: comprehensive review and evaluation of the role of endovascular treatment","volume":"115","author":"Ghali","year":"2013","unstructured":"Ghali MGGhali EZ.Intracavernous internal carotid artery mycotic aneurysms: comprehensive review and evaluation of the role of endovascular treatment. Clin Neurol Neurosurg. 2013;115(10):1927-1942."},{"issue":"7","key":"bib4","series-title":"J Neurointerv Surg","first-page":"708","article-title":"Infectious intracranial aneurysms: a systematic review of epidemiology, management, and outcomes","volume":"10","author":"Alawieh","year":"2018","unstructured":"Alawieh AChaudry MITurner RDTurk ASSpiotta AM.Infectious intracranial aneurysms: a systematic review of epidemiology, management, and outcomes. J Neurointerv Surg. 2018;10(7):708-716."},{"issue":"5","key":"bib5","series-title":"Clin Infect Dis","first-page":"634","article-title":"Epidemiology and outcome of zygomycosis: a review of 929 reported cases","volume":"41","author":"Roden","year":"2005","unstructured":"Roden MMZaoutis TEBuchanan WLEpidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis. 2005;41(5):634-653."},{"issue":"2","key":"bib6","series-title":"Neurol Med Chir (Tokyo)","first-page":"89","article-title":"Fungal internal carotid artery aneurysm treated by trapping and high-flow bypass: a case report and literature review","volume":"56","author":"Yamaguchi","year":"2016","unstructured":"Yamaguchi JKawabata TMotomura AHatano NSeki Y.Fungal internal carotid artery aneurysm treated by trapping and high-flow bypass: a case report and literature review. Neurol Med Chir (Tokyo). 2016;56(2):89-94."},{"issue":"4","key":"bib7","series-title":"Neuroimaging Clin N Am","first-page":"569","article-title":"Fungal sinusitis","volume":"25","author":"Raz","year":"2015","unstructured":"Raz EWin WHagiwara MLui YWCohen BFatterpekar GM.Fungal sinusitis. Neuroimaging Clin N Am. 2015;25(4):569-576."},{"issue":"12","key":"bib8","series-title":"Clin Infect Dis","first-page":"e156","article-title":"Fungal internal carotid artery aneurysms: successful embolization of an Aspergillus-associated case and review","volume":"45","author":"Hot","year":"2007","unstructured":"Hot AMazighi MLecuit MFungal internal carotid artery aneurysms: successful embolization of an Aspergillus-associated case and review. Clin Infect Dis. 2007;45(12):e156-e161."},{"issue":"3","key":"bib9","series-title":"Angiology","first-page":"251","article-title":"Mycotic (Aspergillus) arteritis resulting in fatal subarachnoid hemorrhage: a case report","volume":"42","author":"Lau","year":"1991","unstructured":"Lau AHTakeshita MIshii N.Mycotic (Aspergillus) arteritis resulting in fatal subarachnoid hemorrhage: a case report. Angiology. 1991;42(3):251-255."},{"issue":"4","key":"bib10","series-title":"AJNR Am J Neuroradiol","first-page":"823","article-title":"Retrospective review of cerebral mycotic aneurysms in 26 patients: focus on treatment in strongly immunocompromised patients with a brief literature review","volume":"34","author":"Allen","year":"2013","unstructured":"Allen LMFowler AMWalker CRetrospective review of cerebral mycotic aneurysms in 26 patients: focus on treatment in strongly immunocompromised patients with a brief literature review. AJNR Am J Neuroradiol. 2013;34(4):823-827."},{"issue":"5","key":"bib11","series-title":"AJNR Am J Neuroradiol","first-page":"858","article-title":"Mycotic aneurysm and cerebral infarction resulting from fungal sinusitis: imaging and pathologic correlation","volume":"22","author":"Hurst","year":"2001","unstructured":"Hurst RWJudkins ABolger WChu ALoevner LA.Mycotic aneurysm and cerebral infarction resulting from fungal sinusitis: imaging and pathologic correlation. AJNR Am J Neuroradiol. 2001;22(5):858-863."},{"issue":"7","key":"bib12","series-title":"No Shinkei Geka","first-page":"779","article-title":"Interesting radiological and pathological findings of the internal carotid artery observed in a case of cavernous sinusitis (author\u2019s transl)","volume":"5","author":"Moriyama","year":"1977","unstructured":"Moriyama TFujita YOno HMori K.Interesting radiological and pathological findings of the internal carotid artery observed in a case of cavernous sinusitis (author\u2019s transl). Article in Japanese. No Shinkei Geka. 1977;5(7):779-784."},{"key":"bib13","series-title":"World Neurosurg","first-page":"e242","article-title":"Outcomes after endovascular treatment of direct carotid cavernous fistulas: systematic review and meta-analysis","volume":"170","author":"Hoffman","year":"2023","unstructured":"Hoffman HAshok Kumar AWood JSOutcomes after endovascular treatment of direct carotid cavernous fistulas: systematic review and meta-analysis. World Neurosurg. 2023;170:e242-e255."},{"issue":"5","key":"bib14","series-title":"J Neuroradiol","first-page":"329","article-title":"The recovery time of traumatic carotid-cavernous fistula-induced oculomotor nerve paresis after endovascular treatment with detachable balloons","volume":"41","author":"Liu","year":"2014","unstructured":"Liu YCDuan CZGu DQThe recovery time of traumatic carotid-cavernous fistula-induced oculomotor nerve paresis after endovascular treatment with detachable balloons. J Neuroradiol. 2014;41(5):329-335."},{"issue":"4","key":"bib15","series-title":"J Korean Neurosurg Soc","first-page":"229","article-title":"Bilateral visual loss as a sole manifestation complicating carotid cavernous fistula","volume":"49","author":"Yu","year":"2011","unstructured":"Yu JKHwang GSheen SHCho YJ.Bilateral visual loss as a sole manifestation complicating carotid cavernous fistula. J Korean Neurosurg Soc. 2011;49(4):229-230."},{"key":"bib16","series-title":"Surg Neurol Int","first-page":"392","article-title":"Ruptured fungal mycotic internal carotid artery aneurysm successfully treated with stent-assisted coil embolization: a case report","volume":"13","author":"Sano","year":"2022","unstructured":"Sano NIkeda HTsujimoto YRuptured fungal mycotic internal carotid artery aneurysm successfully treated with stent-assisted coil embolization: a case report. Surg Neurol Int. 2022;13:392."},{"issue":"10","key":"bib1","series-title":"J Fla Med Assoc","first-page":"863","article-title":"Mucormycosis associated with carotid cavernous fistula and cavernous carotid mycotic aneurysm","volume":"76","author":"Saff","year":"1989","unstructured":"Saff GFrau MMurtagh FRSilbiger ML.Mucormycosis associated with carotid cavernous fistula and cavernous carotid mycotic aneurysm. J Fla Med Assoc. 1989;76(10):863-865."},{"issue":"5-6","key":"bib2","series-title":"Mycopathologia","first-page":"425","article-title":"Fungal mycotic aneurysm of the internal carotid artery associated with sphenoid sinusitis in an immunocompromised patient: a case report and review of the literature","volume":"181","author":"Azar","year":"2016","unstructured":"Azar MMAssi RPatel NMalinis MF.Fungal mycotic aneurysm of the internal carotid artery associated with sphenoid sinusitis in an immunocompromised patient: a case report and review of the literature. Mycopathologia. 2016;181(5-6):425-433."},{"issue":"10","key":"bib3","series-title":"Clin Neurol Neurosurg","first-page":"1927","article-title":"Intracavernous internal carotid artery mycotic aneurysms: comprehensive review and evaluation of the role of endovascular treatment","volume":"115","author":"Ghali","year":"2013","unstructured":"Ghali MGGhali EZ.Intracavernous internal carotid artery mycotic aneurysms: comprehensive review and evaluation of the role of endovascular treatment. Clin Neurol Neurosurg. 2013;115(10):1927-1942."},{"issue":"7","key":"bib4","series-title":"J Neurointerv Surg","first-page":"708","article-title":"Infectious intracranial aneurysms: a systematic review of epidemiology, management, and outcomes","volume":"10","author":"Alawieh","year":"2018","unstructured":"Alawieh AChaudry MITurner RDTurk ASSpiotta AM.Infectious intracranial aneurysms: a systematic review of epidemiology, management, and outcomes. J Neurointerv Surg. 2018;10(7):708-716."},{"issue":"5","key":"bib5","series-title":"Clin Infect Dis","first-page":"634","article-title":"Epidemiology and outcome of zygomycosis: a review of 929 reported cases","volume":"41","author":"Roden","year":"2005","unstructured":"Roden MMZaoutis TEBuchanan WLEpidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis. 2005;41(5):634-653."},{"issue":"2","key":"bib6","series-title":"Neurol Med Chir (Tokyo)","first-page":"89","article-title":"Fungal internal carotid artery aneurysm treated by trapping and high-flow bypass: a case report and literature review","volume":"56","author":"Yamaguchi","year":"2016","unstructured":"Yamaguchi JKawabata TMotomura AHatano NSeki Y.Fungal internal carotid artery aneurysm treated by trapping and high-flow bypass: a case report and literature review. Neurol Med Chir (Tokyo). 2016;56(2):89-94."},{"issue":"4","key":"bib7","series-title":"Neuroimaging Clin N Am","first-page":"569","article-title":"Fungal sinusitis","volume":"25","author":"Raz","year":"2015","unstructured":"Raz EWin WHagiwara MLui YWCohen BFatterpekar GM.Fungal sinusitis. Neuroimaging Clin N Am. 2015;25(4):569-576."},{"issue":"12","key":"bib8","series-title":"Clin Infect Dis","first-page":"e156","article-title":"Fungal internal carotid artery aneurysms: successful embolization of an Aspergillus-associated case and review","volume":"45","author":"Hot","year":"2007","unstructured":"Hot AMazighi MLecuit MFungal internal carotid artery aneurysms: successful embolization of an Aspergillus-associated case and review. Clin Infect Dis. 2007;45(12):e156-e161."},{"issue":"3","key":"bib9","series-title":"Angiology","first-page":"251","article-title":"Mycotic (Aspergillus) arteritis resulting in fatal subarachnoid hemorrhage: a case report","volume":"42","author":"Lau","year":"1991","unstructured":"Lau AHTakeshita MIshii N.Mycotic (Aspergillus) arteritis resulting in fatal subarachnoid hemorrhage: a case report. Angiology. 1991;42(3):251-255."},{"issue":"4","key":"bib10","series-title":"AJNR Am J Neuroradiol","first-page":"823","article-title":"Retrospective review of cerebral mycotic aneurysms in 26 patients: focus on treatment in strongly immunocompromised patients with a brief literature review","volume":"34","author":"Allen","year":"2013","unstructured":"Allen LMFowler AMWalker CRetrospective review of cerebral mycotic aneurysms in 26 patients: focus on treatment in strongly immunocompromised patients with a brief literature review. AJNR Am J Neuroradiol. 2013;34(4):823-827."},{"issue":"5","key":"bib11","series-title":"AJNR Am J Neuroradiol","first-page":"858","article-title":"Mycotic aneurysm and cerebral infarction resulting from fungal sinusitis: imaging and pathologic correlation","volume":"22","author":"Hurst","year":"2001","unstructured":"Hurst RWJudkins ABolger WChu ALoevner LA.Mycotic aneurysm and cerebral infarction resulting from fungal sinusitis: imaging and pathologic correlation. AJNR Am J Neuroradiol. 2001;22(5):858-863."},{"issue":"7","key":"bib12","series-title":"No Shinkei Geka","first-page":"779","article-title":"Interesting radiological and pathological findings of the internal carotid artery observed in a case of cavernous sinusitis (author\u2019s transl)","volume":"5","author":"Moriyama","year":"1977","unstructured":"Moriyama TFujita YOno HMori K.Interesting radiological and pathological findings of the internal carotid artery observed in a case of cavernous sinusitis (author\u2019s transl). Article in Japanese. No Shinkei Geka. 1977;5(7):779-784."},{"key":"bib13","series-title":"World Neurosurg","first-page":"e242","article-title":"Outcomes after endovascular treatment of direct carotid cavernous fistulas: systematic review and meta-analysis","volume":"170","author":"Hoffman","year":"2023","unstructured":"Hoffman HAshok Kumar AWood JSOutcomes after endovascular treatment of direct carotid cavernous fistulas: systematic review and meta-analysis. World Neurosurg. 2023;170:e242-e255."},{"issue":"5","key":"bib14","series-title":"J Neuroradiol","first-page":"329","article-title":"The recovery time of traumatic carotid-cavernous fistula-induced oculomotor nerve paresis after endovascular treatment with detachable balloons","volume":"41","author":"Liu","year":"2014","unstructured":"Liu YCDuan CZGu DQThe recovery time of traumatic carotid-cavernous fistula-induced oculomotor nerve paresis after endovascular treatment with detachable balloons. J Neuroradiol. 2014;41(5):329-335."},{"issue":"4","key":"bib15","series-title":"J Korean Neurosurg Soc","first-page":"229","article-title":"Bilateral visual loss as a sole manifestation complicating carotid cavernous fistula","volume":"49","author":"Yu","year":"2011","unstructured":"Yu JKHwang GSheen SHCho YJ.Bilateral visual loss as a sole manifestation complicating carotid cavernous fistula. J Korean Neurosurg Soc. 2011;49(4):229-230."},{"key":"bib16","series-title":"Surg Neurol Int","first-page":"392","article-title":"Ruptured fungal mycotic internal carotid artery aneurysm successfully treated with stent-assisted coil embolization: a case report","volume":"13","author":"Sano","year":"2022","unstructured":"Sano NIkeda HTsujimoto YRuptured fungal mycotic internal carotid artery aneurysm successfully treated with stent-assisted coil embolization: a case report. 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