5) Carotid-cavernous fistula

Q: What are the types of CC fistulas?

A: Direct, Indirect

these refer to

Direct fistula between the ICA and the cavernous sinus

Indirect fistula from dural branches from the ECA or ICA to the cavernous sinus

Q: What are clinical indications to treat a CC fistula?

A: 1) cosmesis

2) increased intraocular pressure, presumably increased venous pressure can cause glaucoma

3) cortical venous drainage (can lead to venous hypertension, ischemia/infarct, or even hemorrhage/death)

Q: What should one look for on f/u imaging studies?

A: Evidence of a cortical venous drainage (best test gado MR venogram "canadian protocol")

Case in Point mentions the Barrow Classification

A direct

B indirect supplied by ICA meningeal branches

C indirect supplied by ECA meningeal branches

D indirect supplied by ICA and ECA meningeal branches

References:

Case in point 3/6/2008 CT only from MS Beth Israel

Case in point 8/7/2014 direct with pulsatile exophthalmos

Case in point 8/19/2014 indirect with brainstem edema

Case in point 9/12/2014 indirect CC fistula with angio!

Angio in this case shows dural branches from the ICA. This can be a little difficult to differentiate from a direct fistula.

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