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. [ 2]
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.
Media Gallery
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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.
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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.
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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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