Diagnosis and therapy of carotid cavernous fistula with ocular complications

Abstract

Objective To investigate the clinical diagnosis and therapy of carotid cavernous fistula with ocular complications.Methods A retrospective study covering 20 patients who was diagnosed with carotid cavernous fistula in Department of Neurological Surgery,First Municipal People's Hospital of Guangzhou,Guangzhou,was performed.Clinical data from all patients including the medical history,ocular manifestations,color fundus photographs,ocular and intracranial pressure,magnetic resonance imaging (MRI),and digital subtraction angiography (DSA),were reviewed.Results In 20 patients (40 eyes) with ocular symptoms,decreased visual acuity occurred in 14 cases (28 eyes;70％),diplopia in 8 patients (16 eyes; 40％),conjunctival congestion and edema in 13 cases (26 eyes; 65％),proptosis in 10 cases (20 eyes; 50％),orbital temporal noise in 6 cases (12 eyes; 30％),ophthalmoplegia in 12 cases (24 eyes; 60％),pathologic fundus changes in 11 patients (22 eyes;55％),ocular pressure increase in 7 cases (14 eyes; 35％).All patients were cured successfully after endovascular embolization treatment.Conclusions Carotid cavernous fistula should be considered as an important differential diagnosis in patients presented with conjunctival hyperemia,proptosis,ophthalmoplegia,or glaucoma.The DSA examination can contribute to a definite diagnosis of carotid cavernous fistula,and the endovascular embolization is the first preferred treatment. Key words: Carotid cavernous fistula; Diagnosis ; Therapy; Complication