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Fistula, Carotid Cavernous: Differential Diagnoses & Workup
Updated: Feb 27, 2007
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Differential Diagnoses
Other Problems to Be Considered
Orbital pseudotumor
Any spheno-orbital mass lesion
Workup
Imaging Studies
- Direct carotid-cavernous sinus fistulae: Computed tomography (CT) scan, magnetic resonance imaging (MRI), and orbital echography often help to confirm the diagnosis, demonstrating extraocular muscle enlargement, dilation of one or both superior ophthalmic veins, and enlargement of the affected cavernous sinus.
- Dural carotid-cavernous sinus fistulae: CT scan, MRI, and orbital echography may help to confirm the diagnosis.
- All carotid-cavernous sinus fistulae
- The definitive diagnostic test is cerebral arteriography with selective catheterization of the internal and external carotid arteries on both sides, so that all arterial contributions to the fistulae can be visualized.
- Intra-arterial subtraction angiography is generally the preferred technique.
Other Tests
- Tonometry (preferably with a pneumotonometer) usually demonstrates greater pulse amplitude on the side of the lesion.
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Differential Diagnoses & Workup: Fistula, Carotid Cavernous |
| Treatment & Medication: Fistula, Carotid Cavernous |
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References
Debrun GM, Vinuela F, Fox AJ, et al. Indications for treatment and classification of 132 carotid-cavernous fistulas. Neurosurgery. Feb 1988;22(2):285-9. [Medline].
Higginbotham EJ. Glaucoma associated with increased episcleral venous pressure. In: Albert DM, Jakobiec FA, eds. Principles and Practice of Ophthalmology. 2nd ed. 2000: 2781-92.
Ishijima K, Kashiwagi K, Nakano K, et al. Ocular manifestations and prognosis of secondary glaucoma in patients with carotid-cavernous fistula. Jpn J Ophthalmol. Nov-Dec 2003;47(6):603-8. [Medline].
Keltner JL, Satterfield D, Dublin AB, Lee BC. Dural and carotid cavernous sinus fistulas. Diagnosis, management, and complications. Ophthalmology. Dec 1987;94(12):1585-600. [Medline].
Kirsch M, Henkes H, Liebig T, et al. Endovascular management of dural carotid-cavernous sinus fistulas in 141 patients. Neuroradiology. Jul 2006;48(7):486-90. [Medline].
Miller NR. Carotid-cavernous sinus fistulas. In: Miller NR, ed. Walsh and Hoyt's Clinical Neuro-Ophthalmology. 4th ed. Baltimore, Md: Williams;1991: 2165-209.
Rai AT, Sivak-Callcott JA, Larzo C, Marano GD. Direct carotid cavernous fistula in infancy: presentation and treatment. AJNR Am J Neuroradiol. Jun-Jul 2004;25(6):1083-5. [Medline].
Troost BT, Glaser JS, Morris PP. Aneurysms, arteriovenous communications, and related vascular malformations. In: Glaser, ed. Neuro-ophthalmology. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins;1999: 589-628.
de Keizer R. Carotid-cavernous and orbital arteriovenous fistulas: ocular features, diagnostic and hemodynamic considerations in relation to visual impairment and morbidity. Orbit. Jun 2003;22(2):121-42. [Medline].
Further Reading
Keywords
carotid cavernous fistula, carotid-cavernous sinus fistula, carotid artery, cavernous sinus
Differential Diagnoses & Workup: Fistula, Carotid Cavernous