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

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