Central Retinal Vein Occlusion During Embolization for Carotid Cavernous Sinus Fistula

Most trauma induced fistulas are direct communications between the intracavernous carotid artery and the cavernous sinus. Theses abnormal communications are characterized by high pressure, high blood flow and a clinically obvious constellation of symptoms and signs. We here in report a patient with traumatic carotid cavernous sinus fistula(CCSF). who developed central retinal vein occlusion(CRVO) during detachable balloon embolization. The mechanism of CRVO occurring during detachable balloon embolization. The mechanism of CRVO occurring during detachable ballon embolization for CCSF was discussed. We report this case with the review of previous reports.

Carotid-Cavernous Fistula

Carotid-cavernous fistula(CCF) is the most common arteria-venous fistula in the head and neck region which has characteristic ophthalmic findings and threat of visual loss. An analysis of clinical records was done of 21 CCF patients who visited the Department of Ophthalmology, Seoul National University Hospital from August 1, 1986 to July 31, 1990. Seventeen cases(81.0%) were of the direct type, and four cases(19.0%) were of the indirect or spontaneous type. Fifteen patients(88.2%) of the direct type had a definite history of recent head trauma. Clinical symptoms on the first visit included exophthalmos(76.2%), conjunctival injection(76.2%), noise in cranial cavity(76.2%), visual disturbance(61.9%), diplopia(42.9%), and ocular pain(28.6%). In general ocular examination, exophthalmometry revealed proptosis in all cases. In seventeen cases(81.0%) vascular bruit was heard with auscultation on the eyelid. Eleven cases(52.4%) showed a limitation of ocular movement and sixth nerve palsy was the most common type(45.5%). On funduscopic examination, nine patients(42.9%) showed engorged retinal vessels. Increased intraocular pressure(Ta>21 mmHg) was recorded in 9 patients(42.9%). Computerized tomography(CT) of orbit or brain, and percutaneous transarterial carotid angiography were used as a diagnostic procedure in all patients. In thirteen of 17 direct type patients detachable balloon embolization was done at the time of angiography, and in 12 cases(92.3%) fistulas were successfully embolized.