eMedicine Specialties > Neurosurgery > Vascular

Caroticocavernous Fistula: Workup

Author: Michael G Nosko, MD, PhD, Chief, Division of Neurosurgery, Director of Neurovascular Surgery, Medical Director of Neuroscience Unit, Associate Professor, Department of Surgery, University of Medicine and Dentistry at New Jersey
Contributor Information and Disclosures

Updated: May 27, 2009

Workup

Laboratory Studies

  • Routine preangiography workup to evaluate coagulation and renal function prior to delivering contrast dye includes the following:
    • CBC count
    • Platelets
    • PT and PTT
  • Electrolytes
  • BUN
  • Creatinine

Imaging Studies

  • Selective carotid angiography (see Image 2)
    • Diagnostic test of choice
    • Helps confirm diagnosis
    • Helps determine type classification
    • Provides therapeutic capability
  • CT scan of orbit
    • Contrast CT scan of the orbit - Helps establish diagnosis
    • May demonstrate proptosis, swelling of extraocular muscles, and dilation of superior ophthalmic vein4
  • Orbital ultrasound - Demonstrates same findings as CT scan

Other Tests

  • Complete ophthalmologic workup includes the following:
    • Visual acuity
    • Pupillary function
    • Intraocular pressure
    • Funduscopy (direct and indirect)
    • Gonioscopy

More on Caroticocavernous Fistula

Overview: Caroticocavernous Fistula
Workup: Caroticocavernous Fistula
Treatment: Caroticocavernous Fistula
Follow-up: Caroticocavernous Fistula
Multimedia: Caroticocavernous Fistula
References

References

  1. Barrow DL, Spector RH, Braun IF. Classification and treatment of spontaneous carotid-cavernous sinus fistulas. J Neurosurg. Feb 1985;62(2):248-56. [Medline].

  2. Karaman E, Isildak H, Haciyev Y, Kaytaz A, Enver O. Carotid-cavernous fistula after functional endoscopic sinus surgery. J Craniofac Surg. Mar 2009;20(2):556-8. [Medline].

  3. Hieshima GB, Cahan LD, Mehringer CM. Spontaneous arteriovenous fistulas of cerebral vessels in association with fibromuscular dysplasia. Neurosurgery. Apr 1986;18(4):454-8. [Medline].

  4. Bacon KT, Duchesneau PM, Weinstein MA. Demonstration of the superior ophthalmic vein by high resolution computed tomography. Radiology. Jul 1977;124(1):129-31. [Medline].

  5. Dandy WE, Follis RH Jr. On the pathology of carotid-cavernous aneurysms (pulsating exophthalmos). Am J Ophthalmol. 1941;24:365-385.

  6. Debrun GM, Vinuela F, Fox AJ. Indications for treatment and classification of 132 carotid-cavernous fistulas. Neurosurgery. Feb 1988;22(2):285-9. [Medline].

  7. Hamby WB. Carotid-cavernous fistula. Springfield, Ill: Charles C Thomas. 1966.

  8. Newton TH, Hoyt WF. Dural arteriovenous shunts in the region of the cavernous sinus. Neuroradiology. 1970;1:71-81.

  9. Serbinenko FA. Balloon catheterization and occlusion of major cerebral vessels. J Neurosurg. Aug 1974;41(2):125-45. [Medline].

  10. Walker AE, Allegre GE. Carotid-cavernous fistulas. Surgery. 1956;39:411-422.

Further Reading

Keywords

caroticocavernous fistula, cc fistula, dural arteriovenous fistula, arteriovenous shunting, type A caroticocavernous fistulas, type B caroticocavernous fistulas, type C caroticocavernous fistulas, type D caroticocavernous fistulas, intracavernous vessels, intracavernous arteries, intracavernous aneurysm, fibromuscular dysplasia, Ehlers-Danlos syndrome, collagen vascular diseases, atherosclerotic vascular disease, ophthalmic venous hypertension, orbital venous congestion, proptosis, chemosis, arterialization of episcleral veins, diplopia, visual loss, III cranial nerve palsy, IV cranial nerve palsy, V cranial nerve palsy, VI cranial nerve palsy, cranial nerve paralysis, central retinal vein occlusion, retinopathy, glaucoma, bruit, headache, visual loss, intracavernous internal carotid artery, cavernous sinus, dural shunt

Contributor Information and Disclosures

Author

Michael G Nosko, MD, PhD, Chief, Division of Neurosurgery, Director of Neurovascular Surgery, Medical Director of Neuroscience Unit, Associate Professor, Department of Surgery, University of Medicine and Dentistry at New Jersey
Michael G Nosko, MD, PhD is a member of the following medical societies: Academy of Medicine of New Jersey, Alpha Omega Alpha, American Association of Neurological Surgeons, American College of Surgeons, American Heart Association, American Medical Association, New York Academy of Sciences, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Medical Editor

Duc Hoang Duong, MD, Professor, Chief Physician, Departments of Neurological Surgery and Neuroscience, Epilepsy Center, Charles Drew University of Medicine and Science
Duc Hoang Duong, MD is a member of the following medical societies: American Neurological Association, Congress of Neurological Surgeons, and North American Skull Base Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Ryszard M Pluta, MD, PhD, Associate Professor, Neurosurgical Department Medical Research Center, Polish Academy of Sciences at Warsaw, Poland; Senior Researcher, Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, NIH
Ryszard M Pluta, MD, PhD is a member of the following medical societies: Congress of Neurological Surgeons and Polish Society of Neurosurgeons
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

Allen R Wyler, MD, Former Medical Director, Northstar Neuroscience, Inc
Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons
Disclosure: Nothing to disclose.

 
 
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