Clinical analysis and ocular manifestation in 16 patients with carotid cavernous fistula

Objective To analyze the clinical features and differential diagnosis of carotid cavernous sinus fistulas( CCF)in order to improve the recognition and avoid misdiagnosis. Methods Clinical data from 16 patients with carotid- cavernous sinus fistula including ocular manifestation,imaging,treatment were analyzed retrospectively. Differences between the direct and the indirect CCF were compared. Results The most common signs of CCF were conjunctival injection or chemosis( 93. 8%) and proptosis( 81. 3%). Intracranial vascular murmur was more prevalent in patients with direct CCF. CCF may be misdiagnosed as glaucoma,thyroid associated ophthalmopathy,and orbital inflammatory pseudotumor. The ocular symptoms improved apparently in all cases after embolization therapy. Conclusion Although the ocular manifestation of carotid cavernous fistula are varied,combination of medical history,characteristic ocular signs and DSA imaging examination can improve the diagnosis. Endovascular embolization is a suitable treatment of the CCF with good prognosis.