Carotid-cavernous fistula

Carotid-cavernous fistula is a pathological communication between the internal carotid artery and the cavernous sinus. It can arise spontaneously, due to the rupture of a cavernous aneurysm or post-traumatically. As a result of this communication, part of the blood primarily going to the internal carotid artery flows into the cavernous sinus and the veins of the orbit ( steal phenomenon ).

Clinical picture
The defect is manifested by a murmur (above the temple or above the eye), pulsating exophthalmos, conjunctival chemosis , dilated veins on and around the eye, and sometimes visual disturbances.

Therapy
To prove the sufficiency of the flow, the so-called Matas test is performed - compression of the carotid artery on the affected side during an angiographic examination, while we determine whether blood reaches both hemispheres (collateral river). With good collateral flow, the internal carotid artery can be ligated. Today, however, endovascular surgery is preferred, where a balloon is introduced into the fistula and a. carotid int. is allowed to pass through. Direct operation of the cavernous sphincter is difficult and not routinely performed.