Caroticocavernous fistula

Case contributed by Dr Laughlin Dawes

The above axial maximum-intensity projection slab from a CT cerebral angiogram shows dilatation of both superior ophthalmic veins and engorgement of the cavernous sinuses. The appearance is consistent with caroticocavernous fistula. 

Case Discussion

Digital subtraction angiography (not shown) demonstrated the fistula to be of the indirect (low-flow) type.

Caroticocavernous fistula can be classified as direct (high-flow) or indirect (low-flow). High flow fistulas are due to a direct communication and are usually due to trauma or rupture of cavernous ICA aneurysm. Indirect fistulas are due to communication by multiple dural branches of ECA +/- ICA, and are postulated to occur secondary to cavernous sinus thrombosis with revascularisation.

Endovascular treatment of direct fistulas may be by transarterial (via ICA rent into cavernous sinus) or transvenous (inferior petrosal sinus or superior ophthalmic vein) routes. Indirect fistulas typically require a combined transarterial (closure of feeders) and transvenous (closure of cavernous sinus) approach. 

Credit: Dr Laughlin Dawes and Dr Constantine Phatouros.

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Case information

rID: 35996
Case created: 24th Apr 2015
Last edited: 6th Nov 2015
Inclusion in quiz mode: Included

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