Carotid-cavernous fistula

Current concepts in aetiology, investigation, and management

Amanda Henderson, N. R. Miller

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

A carotid-cavernous fistula (CCF) is an abnormal communication between arteries and veins within the cavernous sinus and may be classified as either direct or dural. Direct CCFs are characterized by a direct connection between the internal carotid artery (ICA) and the cavernous sinus, whereas dural CCFs result from an indirect connection involving cavernous arterial branches and the cavernous sinus. Direct CCFs frequently are traumatic in origin and also may be caused by rupture of an ICA aneurysm within the cavernous sinus, Ehlers-Danlos syndrome type IV, or iatrogenic intervention. Causes of dural CCFs include hypertension, fibromuscular dysplasia, Ehlers-Danlos type IV, and dissection of the ICA. Evaluation of a suspected CCF often involves non-invasive imaging techniques, including standard tonometry, pneumotonometry, ultrasound, computed tomographic scanning and angiography, and/or magnetic resonance imaging and angiography, but the gold standard for classification and diagnosis remains digital subtraction angiography. When a direct CCF is confirmed, first-line treatment is endovascular intervention, which may be accomplished using detachable balloons, coils, liquid embolic agents, or a combination of these tools. As dural CCFs often resolve spontaneously, low-risk cases may be managed conservatively. When invasive treatment is warranted, endovascular intervention or stereotactic radiosurgery may be performed. Modern endovascular techniques offer the ability to successfully treat CCFs with a low morbidity and virtually no mortality.

Original languageEnglish (US)
Pages (from-to)164-172
Number of pages9
JournalEye (Basingstoke)
Volume32
Issue number2
DOIs
StatePublished - Feb 1 2018
Externally publishedYes

Fingerprint

Cavernous Sinus
Fistula
Internal Carotid Artery
Internal Carotid Artery Dissection
Fibromuscular Dysplasia
Ehlers-Danlos Syndrome
Endovascular Procedures
Digital Subtraction Angiography
Radiosurgery
Magnetic Resonance Angiography
Manometry
Aneurysm
Rupture
Veins
Angiography
Arteries
Magnetic Resonance Imaging
Hypertension
Morbidity
Mortality

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems

Cite this

Carotid-cavernous fistula : Current concepts in aetiology, investigation, and management. / Henderson, Amanda; Miller, N. R.

In: Eye (Basingstoke), Vol. 32, No. 2, 01.02.2018, p. 164-172.

Research output: Contribution to journalArticle

Henderson, Amanda ; Miller, N. R. / Carotid-cavernous fistula : Current concepts in aetiology, investigation, and management. In: Eye (Basingstoke). 2018 ; Vol. 32, No. 2. pp. 164-172.
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