Fig. 17. A 32-year-old woman was accidentally shot in the right eye with a low-velocity missile. The initial recovery was excellent, except for loss of the right eye. Five days after the injury, left proptosis and bruit developed. Two weeks after the injury, she developed paralysis of the left sixth and fourth nerves, and visual acuity decreased to 20/400 (6/120) in her remaining (left) eye. An interventional neuroradiologic procedure was performed with complete return of function in the left eye. A: Left carotid arteriogram with immediate opacification of entire cavernous sinus (arrows). B: One-half second after (A) there was extensive filling of dural venous channels and orbital veins. C: Detachable flow-guided balloon (arrows) placed in the fistula under fluoroscopic control and opacified with contrast medium. D: Follow-up left carotid arteriogram after balloon (arrows) placement. The fistula was completely closed with preservation of carotid flow. (Courtesy of Dr. Charles Kerber.)