Copyright ©2013 Baishideng Publishing Group Co.
World J Radiol. Apr 28, 2013; 5(4): 143-155
Published online Apr 28, 2013. doi: 10.4329/wjr.v5.i4.143
Table 1 Carotid cavernous sinus fistula
Symptoms and signs
Exophthalmos, proptosis
Cephalic bruit
Conjunctival chemosis, ‘’red eye’’
Pain, headache
Trigeminal nerve dysfunction
Elevated intraocular pressure, secondary glaucoma
Diminished visual acuity, visual loss
Subconjunctival hemorrhages
Corneal damage
Intracranial hemorrhage
Differential diagnosis
Vascular pathologies
Marginal sinus fistulas (with a restriction of venous drainage via the jugular bulb)
Anomalous intracranial venous drainage (sigmoid sinus hypoplasia/aplasia)
Cavernous sinus thrombosis
Intraorbital lesions
Fibrous dysplasia
Frontal sinus mucocele
Ocular neoplasms
Inflammatory, allergic and infectious pathologies
Endocrine pathologies
Thyroid ophthalmopathy
Indications for emergency treatment
Angiographic findings
Large varix of the cavernous sinus
Venous drainage to cortical veins
Thrombosis of distant venous outflow pathways
Clinical signs and symptoms
Increased intracranial pressure
Rapidly progressive proptosis
Intracerebral, subarachnoid and external hemorrhage
Transient ischemic attack
Treatment modalities
Conservative management (manual compression therapy and medical therapy)
Surgical management
Stereotactic radiosurgery
Endovascular management
Direct fistula
Transarterial treatment (preferred approach for direct CCF)
Detachable balloon occlusion
Transarterial coil and material embolization
Covered stent graft placement (endovascular reconstruction of the parent artery)
Parent artery occlusion
Transvenous treatment
Transvenous detachable coil embolization
Liquid embolizing agents (n-BCA, Onyx)
Indirect fistula
Transvenous treatment (preferred approach for indirect CCF)
Transvenous detachable coil embolization
Liquid embolizing agents (n-BCA, Onyx)
Transarterial treatment
Transarterial coil and material embolization