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Chapter-056 Carotid Cavernous Fistulae

BOOK TITLE: Textbook of Contemporary Neurosurgery (2 Volumes)

Author
1. Karapurkar Anil P
2. Aditya Nishant K
ISBN
9789350252390
DOI
10.5005/jp/books/11681_56
Edition
1/e
Publishing Year
2012
Pages
10
Author Affiliations
1. Sir Hurkisondas Nurrotumdas Hospital, Mumbai, Maharashtra, India, Breach Candy, Saifee, Fortis Hospitals, Mumbai, Maharashtra, India
2. Sir Hurkisondas Nurrotumdas Hospital, Mumbai, Maharashtra, India
Chapter keywords

Abstract

This chapter reviews the different types of carotid cavernous fistulas (CCFs), and their management. Post-traumatic CCFs are common, especially after a closed head injury. Traumatic rupture of ICA (direct type) and spontaneous cavernous sinus thrombosis are other common causes.· The CCFs are characterized by a direct connection between the cavernous ICA and the cavernous sinus (direct type–high-flow) or commonly, a communication between the cavernous sinus and one or more meningeal branches of the ICA, ECA, or both (indirect type–low-flow). In direct types clinical features are dominated by manifestations related to the anterior drainage (because of superior ophthalmic vein outflow), such as, conjunctival chemosis, pulsatile proptosis and diplopia. Visual loss is the most feared event. Indirect types are due to rupture of one of the smaller dural branches and have milder signs and symptoms. Visual threat is the most feared. Conservative treatment is accepted since many of the indirect types resolve spontaneously (50% of low-flow ones). Endovascular intervention is the treatment of choice for CCF. Surgery may involve ligation of the common or internal carotid artery if embolization fails. A combined extra and intradural full exposure of the cavernous sinus and its contents, with identification and direct obliteration of all arterial input and selective ablation of the venous outflow from the cavernous sinus and direct coiling of the fistula have been reported.

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