Introduction: Carotid cavernous fistulae (CCF) are rare, and they occur when there is
a communication between the internal carotid artery (ICA) and cavernous sinus. These lesions are
associated with blunt or penetrating traumatic injuries of the carotid arteries. We present the first
cases of cavernous dural arteriovenous fistulae (cDAVF) in the middle meningeal artery (MMA) after
the treatment of direct CCF in the ICA with Willis-covered stents (WCSs).
Case Presentation: Our patients comprised 22 and 50-year-old males with histories of head injuries
months before admission at our facility. In both patients above, cerebral angiography revealed
fistulae in the right ICA and left ICA, respectively. They were treated with WCSs via the
trans-artery endovascular route. In both cases, the treatments were not in the way attempted via the
MMA. Subsequently, they developed cDAVF in the middle meningeal artery (MMA), which were
treated with Onyx Liquid Embolic System (Onyx HD-500) (Covidien / ev3 Neurovascular) and
Conclusion: These are the first cases in whom WCSs for the management of direct CCF resulted
in cDAVF at the MMA. The WCSs inside the ICA could have resulted in the cDAVF via unknown
mechanisms but not iatrogenic.