Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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February 27, 2012
Direct Carotid Cavernous Fistula
- Carotid-cavernous fistula (CCF) represents an abnormal communication between the internal carotid artery and the cavernous venous sinus.
- CCFs are further classified as direct (ICA-cavernous sinus) or indirect (dural arteries-cavernous sinus) types. CCFs are either traumatic or spontaneous in etiology.
- Most patients present with exophthalmos, orbital edema, and occasional ecchymosis. A vascular bruit can often be elicited over the involved orbit.
- Key Diagnostic Features: Proptosis, stranding of retrobulbar fat, prominent superior ophthalmic vein, and enlargement of the extra-occular muscles. Fullness in the region of the cavernous sinuses is often seen. An aneurysm is occasionally seen in the region of the left cavernous sinus. A CCF can be demonstrated on CT/MR or conventional DSA.
- DDx: Superior ophthalmic vein varix, orbital arterio-venous malformation
- Rx: Occlusion
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