Acquired carotid-cavernous fistula caused by traumatic intracavernous rupture of an embryonic anastomosis.

This case of traumatic carotid-cavernous fistula was caused by rupture of a peculiar ipsilateral intracavernous anastomosis between the accessory meningeal artery and the redundant deep recurrent ophthalmic artery. In the opposite cavernous sinus there was an obvious anastomosis between the accessory meningeal artery and the ophthalmic artery, probably located in the lateral part of the cavernous sinus. The patient was successfully treated with transarterial embolization followed by surgery of the cavernous sinus. In light of the vascular embryology, it is possible that unusual embryonic connections between the primitive dorsal ophthalmic artery and the accessory meningeal artery already existed in both cavernous sinus areas.