કેરોટીડ કેવરનસ ફીસ્યુલા (સી.સી.એફ. ળ હહા)

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It is an abnormal communication between carotid (brain) artery and cavernous sinus (vascular space behind eyes). The most common (70%) cause is trauma from a basal skull fracture resulting in tear in the internal carotid artery (ICA) within the cavernous sinus. Other cause is rupture of internal carotid artery aneurysm into cavernous sinus. 

There are two types of cavernous sinus.  

1. Direct carotid-cavernous fistulae direct connection between the intra cavernous segment of the internal carotid artery and the cavernous sinus. These fistulae usually have high rates of arterial blood flow and most commonly are caused by a single traumatic tear in the arterial wall. 
2. Indirect carotid-cavernous fistulae are characterised by a communication between the cavernous sinus and tiny branches of external of internal carotid arteries. These fistulae usually have low rates of arterial blood flow. This may develop spontaneously or in association with atherosclerosis, systemic hypertension, collagen vascular disease, pregnancy, and during or after childbirth. 

• Red eye 
• Double vision 
• Decreased vision 
• Bulging eye 
• Bruit (buzzing or swishing sounds) 
• Swollen eye lids 

Progressive eye complications if the fistula is left untreated include: 

• Visual loss. 
• Nasal bleeding and 
• Intracranial haemorrhage which may lead to death 

Treatment is Carotid cavernous sinus fistula embolization. In this procedure through a leg artery or vein a catheter is placed within the cavernous sinus and the sinus compartment harbouring the fistula is occluded. Occlusion may be done with balloon, coils or liquid embolic agent or a combination of them. 

Outcome is mostly satisfactory with gradual resolution of eye lid edema, redness and bulging of eye ball, double vision.