Carotico Cavernous Fistula (CFS)

What is CCF?

It is an abnormal connection between the carotid artery or its branches and a large vein called cavernous sinus. This sinus is located behind the eye and receives blood from it and the brain.

Types of CCF

• Spontaneous: due to rupture of the carotid artery aneurysm into the cavernous sinus.
• Traumatic following a head injury either blunt or penetrating.

What are the symptoms?

Patients present with classic triad of

• Chemosis: red eye
• Pulsatile exophthalmos: abnormal protrusion of the eye
• Ocular bruit: blood flow sounds

Other symptoms are

• proptosis: protrusion of the entire eye
• Diplopia: double vision
• Visual loss: blindness

How is it diagnosed?

• history
• clinical examination
• CT and MRI
• Cerebral angiography

How is it treated?

• there is no medical treatment
• Endovascular treatment
  • Deploying detachable balloons
  • Covered stents
  • Stent assisted coiling
  Sometimes CCF may need to be occluded through a vein
• Surgical: opening the skull and occluding the carotid artery proximal and distal to the fistula. This sis followed by cerebral revascularization by joining the vessels of the face and those of t brain.

Authored By Dr. Sai Sudarsan