Fistula, Carotid-Cavernous

Presenting Symptoms

• Chemosis
• Pulsatile proptosis
• Ocular bruits

Classifications

Barrow Classification

• Type A (direct): high-flow shunts between ICA and CS
• Type B (indirect): meningeal branch of ICA to CS
• Type C (indirect): meningeal branch of ECA to CS
• Type D (indirect): meningeal branch of both ICA and ECA to CS

Treatment

• 20%-50% low flow CCF spontaneously thrombose
• Can observe if intraocular pressure is less than 25
• Endovascular
  • Superior ophthalmic vein vs inferior petrosal sinus
  • Coil is preferred over liquid embolics