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Purpose: We report on a patient who underwent transvenous target embolization of a small, direct carotid-cavernous fistula (CCF). Case: A 74-year-old female without a history of trauma was referred to our department. Tinnitus and ocular symptoms initially occurred as symptoms of a right, direct CCF. Anterograde blood flow at the peripheries of the anterior and middle cerebral arteries was maintained, and an Allcock test confirmed a fistula connecting from the C3 region of the internal carotid artery to the cavernous sinus. Transvenous target embolization of the fistula was performed while protecting the internal carotid artery using a balloon. The use of only a single coil led to the disappearance of the shunt. Conclusion: In some patients, a small, direct CCF can be cured by target embolization. It is important to predict the size of a fistula and clearly visualize the fistulous site in the process of diagnosis.

Transvenous Target Embolization for a Small Sized, Non-traumatic Direct Carotid-cavernous Fistula using a Single Coil: Technical Case Report