Carotid-Cavernous Fistula (CCF) Treatment & Management

Updated: May 24, 2019
  • Author: Ingrid U Scott, MD, MPH; Chief Editor: Hampton Roy, Sr, MD  more...
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Treatment

Medical Care

Exposure keratopathy may be treated with ocular lubricants, and, in severe cases, a tarsorrhaphy may be needed.

Glaucoma may require treatment with aqueous suppressants and hyperosmotic agents.

Laser peripheral iridectomy may be performed to eliminate the contribution of pupillary block, and cycloplegic agents may be used to encourage a posterior shift of the iris-lens diaphragm.

Laser iridoplasty or goniosynechialysis may help further in opening the angle.

Proliferative retinopathy and neovascular glaucoma may require panretinal photocoagulation.

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Surgical Care

The optimal treatment of a direct carotid-cavernous sinus fistula is closure of the abnormal arteriovenous communication with preservation of internal carotid artery patency. Techniques for achieving this result include surgical repair of the damaged portion of the intracavernous internal carotid artery, electrothrombosis, embolization, or balloon occlusion of the fistula. [3, 4, 5, 6]

Dural carotid-cavernous sinus fistulae may close spontaneously, but, for those lesions causing progressive or unacceptable symptoms and signs, standard embolization or endovascular balloon occlusion is generally performed. If these techniques are unsuccessful, direct surgery on the cavernous sinus may be considered. In cases where anatomy makes standard intravascular approach impossible, the superior ophthalmic vein can be cannulated and a balloon or coil threaded into the area of a direct communication.

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Consultations

Neurosurgical consultation for management of the carotid-cavernous fistula

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Long-Term Monitoring

Further outpatient care includes periodic monitoring of the condition.

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