5) Carotid-cavernous fistula
Q: What are the types of CC fistulas?
A:Â 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
https://3s.acr.org/CIP/ArchiveCaseView.aspx?CaseId=K994sRe/z4Y=
Case in point 8/7/2014 direct with pulsatile exophthalmos
Case in point 8/19/2014 indirect with brainstem edema
https://3s.acr.org/CIP/ArchiveCaseView.aspx?CaseId=sy1enJZgOcc%3d
Case in point 9/12/2014 indirect CC fistula with angio!
https://3s.acr.org/CIP/CaseView.aspx?CaseId=uBhf/g4PoOY=
Angio in this case shows dural branches from the ICA. This can be a little difficult to differentiate from a direct fistula.