Clinical Manifestations and Angiographic Ceatures in Carotid – Cavernous sinus Fistula

Abstract

Background : Carotid-cavernous sinus fistula can occur with other injuries. It may have ocular and cerebral complications which cause blindness and paralysis respectively.

Objective : To study ocular manifestations, associated injuries, angiographic features,     complications and mana-gement of patients with carotid-cavernous sinus fistula.

Design : Descriptive study with statistical inference

Setting : Department of Ophthalmology, Srinagarind Hospital

Subjects : Patients diagnosed as carotid-cavernous sinus fistula between January 1990 to December 1999.

Intervention : Patients were treated with muscle embolization.

Measurements : Ocular examination at pre-and post- operation and angiography at pre-operation

Results : 28 Patients, 20 male and 8 female, were diagnosed as carotid-cavernous sinus fistula. Mean age was 30.18 ± 12.42 years. Median duration of injury was30 days. The most common cause injury was motor vehicle accident. Associated maxillofacial, cerebral and base of skull injuries were reported 17.66, 11.76 and 5.88 percent, respectively, The frequent ocular manifestations were proptosis , bruit , episcleral vein engorgement and ophthalmoplegia. Fifty percent of 24 patients who were reported ipsilateral had an    intercavernous connection. The most frequent ocular complication was secondary glaucoma. Fifteen patients were surgically treated and followed regularly. Seven patients recovered completely but eight recovered partially

Conclusions : Carotid – cavernous sinus fistula can occur with maxillofacial injury and head injury. Ocular manifers tations may be in ipsilateral and/or contralateral to lesion. Unless proper operation was performed, it could cause a devastating effect to vision and life.

Key words: Clinical manifestations, Angiographic features, Carotid-cavernous sinus fistula