Indirect Carotid-Cavernous Fistula

Abstract

A 37-year-old female reported suffering from red eye OS and tinnitus for 2 weeks. There was neither reported eye pain nor ocular discharge. She visited our clinic and her vision was 6/6 in both eyes. Intraocular pressure was 14 mmHg in the right eye and 18 mmHg in the left. Her left conjunctiva was severely congested. The cornea, lens, and anterior chambers were clear in both eyes. Fundoscopic examination showed normal fundus in both eyes (Fig. 25.1). A visual field test showed nonspecific changes in the superior fields of both eyes (Fig. 25.1). OCT examination showed mildly decreased peripapillary retinal nerve fiber layer (RNFL) thickness, with an average RNFL thickness of 84 μm in the right eye and 80 μm in the left eye. In addition, there was a homonymous hemi-loss of the left ganglion cell-inner plexiform layer (GC-IPL) in both macular regions (Fig. 25.2). She was admitted for further investigation. A brain MRA showed increased flow void over the left cavernous sinus region and an arteriovenous fistula over the left carotid artery (Fig. 25.3). Carotid angiography showed a left cavernous sinus dural arteriovenous fistula (DAVF), majorly fed by dural branches of the left internal carotid artery (ICA), and draining into the left ophthalmic vein (Fig. 25.4). The patient then received transvenous detachable coil embolization of the left cavernous sinus DAVF. No significant complications or complaints were mentioned after the procedure was performed. The patient was then discharged under stable conditions.