[Carotid-cavernous fistula: clinical and pathological correlations]

Area of Science:

• Vascular Surgery
• Neurology
• Radiology

Background:

• Carotid-cavernous fistulae (CCF) are classified as direct (DCCF) or indirect (ICCF).
• DCCF typically presents with obvious orbital congestion, facilitating diagnosis.
• ICCF, or dural fistulae, often have subtle symptoms, leading to delayed diagnosis and poorer prognosis.

Purpose of the Study:

• To identify characteristic clinical signs differentiating DCCF and ICCF.
• To correlate these signs with angiographic findings of involved vessels.
• To analyze the prognostic implications of both CCF types.

Main Methods:

• Retrospective single-center study of patients with angiographically confirmed DCCF or ICCF.
• Analysis of demographic, clinical, and prognostic data.
• Comparison of clinical findings with angiogram results.

Main Results:

• Four DCCF and two ICCF patients were included; mean age around 62 years.
• Diagnosis delay was significantly longer for ICCF (24 weeks) vs. DCCF (7 weeks).
• Orbital congestion and proptosis were present in all DCCF but absent in ICCF; bruits were common in both, with varied locations.

Conclusions:

• ICCF pose a mortality risk and are frequently underdiagnosed due to subtle clinical presentation.
• Suspicion of ICCF is warranted even with normal initial examination, emphasizing careful auscultation for bruits in all facial locations.
• A strong correlation exists between CCF site, bruit location, and involved vessels, aiding diagnosis.