Caroticocavernous Fistula Workup

  • Author: Michael G Nosko, MD, PhD; Chief Editor: Allen R Wyler, MD   more...
 
Updated: Sep 12, 2011
 

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
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Imaging Studies

  • Selective carotid angiography
    • Diagnostic test of choice
    • Helps confirm diagnosis
    • Helps determine type classification
    • Provides therapeutic capability
    • An angiogram is depicted in the image below. Panel A is an angiogram of caroticocavernous fistuPanel A is an angiogram of caroticocavernous fistula showing filling of the cavernous and circular sinuses. Panel B shows a post-Guglielmi detachable coil, ie, coiling of the fistula. The red arrow points to coils within the cavernous and circular sinuses after obliteration of the fistula.
  • 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 vein[4]
  • Orbital ultrasound - Demonstrates same findings as CT scan
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Other Tests

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

Michael G Nosko, MD, PhD  Associate Professor of Surgery, Chief, Division of Neurosurgery, Medical Director, Neuroscience Unit, Medical Director, Neurosurgical Intensive Care Unit, Director, Neurovascular Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School

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, Canadian Congress of Neurological Sciences, Congress of Neurological Surgeons, New York Academy of Sciences, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Ryszard M Pluta, MD, PhD  Associate Professor, Neurosurgical Department Medical Research Center, Polish Academy of Sciences at Warsaw, Poland; Clinical Staff Scientist, Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH); Fishbein Fellow, JAMA, Chicago ,IL

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.

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.

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.

 
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Type-D caroticocavernous fistula: the eye demonstrates proptosis, chemosis, and scleral edema. The patient is unable to close the eye, exposing the cornea to dehydration and potential trauma.
Panel A is an angiogram of caroticocavernous fistula showing filling of the cavernous and circular sinuses. Panel B shows a post-Guglielmi detachable coil, ie, coiling of the fistula. The red arrow points to coils within the cavernous and circular sinuses after obliteration of the fistula.
This is a diagrammatic representation of the 4 types of caroticocavernous fistulas. ICA is the internal carotid artery; ECA is the external carotid artery.
 
 
 
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