Indirect internal carotid-cavernous fistula in infancy.

Area of Science:

• Ophthalmology
• Pediatric Neurology
• Vascular Surgery

Background:

• Indirect carotid-cavernous sinus fistulas (CCFs) are abnormal connections between the internal carotid artery and the cavernous sinus.
• While CCFs are more common in adults, pediatric cases are rare and often present with distinct clinical features.

Observation:

• A 4-month-old male infant presented with proptosis and episcleral injection, initially suspected as orbital inflammation.
• Diagnostic evaluation revealed an indirect carotid-cavernous sinus fistula originating from the internal carotid artery.

Findings:

• This represents the first reported case of an indirect carotid-cavernous sinus fistula in an infant originating from the internal carotid artery.
• The infant was managed conservatively with no progression of symptoms, suggesting a potentially benign course in select pediatric cases.

Implications:

• This case expands the understanding of indirect CCFs in infants, emphasizing the need for considering vascular etiologies in pediatric proptosis.
• Conservative management may be a viable option for certain pediatric indirect CCFs, warranting further investigation into optimal treatment strategies.