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Carotid Cavernous Fistula

Last modified by XWikiGuest on 2025/06/09 15:20

 

FACTS

arterial or venous connections between ICA / ECA and veins in region of cavernous sinus

direct CCF: direct connection between ICA (or first order branches) and cavernous sinus veins

indirect CCF: dural AV fistulas that are fed by branches of the ICA / ECA

CONSULT

HPI 

  • prior TSS/endoscopic procedures (can cause iatrogenic direct CCFs)
  • connective tissue disorders (spontaneous direct CCFs)
  • traumas 
  • WHOL (rupture of intracavernous aneurysm)

FOCUSED EXAM

Chemosis = swelling of tissue lining eyelids 

Conjunctival Chemosis: What Causes It and How It Is Treated

Exophthalmos (aka proptosis) = protrusion forward of eyelid
- particularly prominent in anteriorly located fisula w/ drainage through superior opthalmic vein

What is Exophthalmos?

Other things to evaluate for:
- Diplopia: due to venous engorgement of orbital contents
- evaluate for pulsatile eye
- can auscultate for bruit over eyelid 

IMG 

 

A/P

[ ] DSA 

For trauamatic direct CCF, high-flow lesions need URGENT endovascular repair while indirect low-flow lesions can tolerate more conservatively timed repair

[ ] optho c/s to evaluate vision, intraocular pressure 

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Notes

 

Figure 1: direct carotid cavernous fistula leading to engorgement of cavernous sinus then superior opthalmic vein (Youmann's) 

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Figure 2: opthalmic veins drain directly into cavernous sinuses, hence the proptosis (Youmann's)

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