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 Presentations: Our patients comprised of 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 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 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 conservatively
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 into the cDAVF via unknown mechanisms but not iatrogenic.