Cavernous carotid fistulas (CCFs) are abnormal connections between the blood vessels that take blood to and from the brain: the internal carotid artery, the external carotid artery, and the cavernous sinus or its dura (the thin membrane that covers the cavernous sinus). The integrity of the cavernous sinus and its dura are particularly important because blood is toxic to a number of nearby sensitive neural tissues.
CCFs are classified as either indirect (type A, or dural) or direct (type B, C, and D). Indirect CCFs are usually spontaneous and have no known cause. Direct CCFs may result from trauma, rupture of a cavernous carotid aneurysm, or a tear in the wall of a weak cavernous internal carotid artery caused by congenital collagen vascular disease.
Symptoms may include bulging eyes, deteriorating vision, and ringing in the ears. Surgical treatment depends on the type of cavernous carotid fistula. Minimally invasive options may include neuroendovascular techniques or embolization.
At UPMC, we take a 360° Approach to treatment when evaluating each patient—looking at their conditions from every direction—to find the path that is least disruptive to the patient's brain, critical nerves, and ability to return to normal functioning. Our neurosurgical team may recommend a combination of surgical and non-surgical approaches to maximize the benefits of surgery while minimizing risks.
Cavernous carotid fistulas can be diagnosed by imaging studies such as CT, MRI scans and angiogram.
Your physician will also ask you about your symptoms. These may include:
- bulging eyes
- swelling of the membranes that cover the outside of the eyes and line the eyelids
- forward displacement of the eyeballs
- deteriorating vision
- cranial nerve palsies
- nosebleed
- headache
- bruit (a blowing sound in the vessel that can be heard with a stethoscope)
- tinnitus (ringing in the ears)
Minimally invasive surgery options may include neuroendovascular techniques or embolization.
At UPMC, we take a 360° Approach to treatment when evaluating each patient—looking at their conditions from every direction—to find the path that is least disruptive to the patient's brain, critical nerves, and ability to return to normal functioning. Our neurosurgical team may recommend a combination of surgical approaches to maximize the benefits of surgery while minimizing risks.
