Duration 5min, Q&A 3min
Carotico-Cavernous Fistula (CCF): Clinical Features and Management Outcome
Carotico-cavernous fistulas (CCF) are vascular shunts between the carotid system and cavernous sinus. We evaluated the demographic profile, clinical features, and management of CCF.
We retrospectively analyzed CCF patients in the period 1999-2012. All patients underwent Digital Subtraction Angiography (DSA) for confirmation of diagnosis and classification. We also noted the initial clinical diagnosis.
20 patients were included in the study. The age range was 19-75 yrs. (Mean 44.65, standard deviation 16.288). The male: female ratio was 3:2. The most common presenting complaint was proptosis (15, 75%); others included diplopia (8, 40%), headache (5, 25%), and tinnitus (4, 20%). Dilated episcleral vessels were present in 100% cases. Other signs included limitation of extraocular movements (13, 65%), chemosis (8, 40%), thrill and bruit (7, 35%), and hemorrhagic retinopathy (2, 10%). Intraocular pressure was raised in 15 (75%) patients (mean 22.9 mm of Hg, standard deviation 5.41). In ten (50%) patients, clinical diagnosis was accurate, while rest was treated initially as either idiopathic orbital inflammatory disease or Thyroid related orbitopathy before referral.
Results and Conclusion
The most common CCF subtype was type D (10, 50%) followed by type A (5, 25%). Manual carotid massage was advised in 10 (50%) cases of indirect CCF, in which nine (90%) had significant clinical improvement with two complete and two partial closures of the fistula. One case did not respond to massage and was treated with embolization. The eleven (55%) cases that underwent intervention (8 balloon, 2 coil and 1 particle embolization) had resolution of symptoms. Two (20%) cases developed cavernous sinus thrombosis after embolization.
CCF is liable to be misdiagnosed. Unilateral episcleral congestion with raised IOP is sensitive clinical parameter. DSA is the gold standard in diagnosis. Manual carotid compression is a safe and effective measure for managing indirect CCF.
[ Keyword ]
Carorico Cavernous fistula / Intervantional Radiology
[ Conflict of Interest ]