246 A Case Report on Bilateral Spontaneous Carotico-Cavernous Fistula with Literature Review. (28th February 2022)

• Record Type: Journal Article
• Authors: Porag, R.; Kulkarni, G.
• Is Part Of: British journal of surgery. Volume 109(2022)Supplement 1
• Publication Date: 2022-02-28
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znac039.160
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Background: CCF is an abnormal vascular communication that allows blood to either directly or indirectly flow from the carotid arteries to the cavernous sinus. We present a rare case of spontaneous bilateral direct CCF. Coil embolization is a very effective treatment for CCF. Case report: 86-year-old lady presented in ED with two weeks history of progressive painful, swollen right eye & drooping of eyelid with double vison in left eye. Patient also had a history of intermittent headache and had pulsatile tinnitus in right ear. There was no history of head or eye trauma. On examination, the lady had proptosis, chemosis and restricted movement in right eye, 3rd nerve palsy in left eye. Corrected vision +0.3 in right eye, +0.1 in left eye. Pupils were bilaterally sluggish, there was no relative afferent pupillary defect. CTA showed bilateral direct CCF along with dilated superior ophthalmic veins on both sides (L>R). No other associated or underlying pathologies were seen. She was started on oral Acetazolamide, Travoprost and Brimonidine topically. Patient was urgently referred to neurosurgery department and Coil embolization of her CCF was done successfully the following day. Eye casualty review was done day after her coil embolization. IOP pressure was decreased to normal limits -12 RE and 8 LE. Although her VA was slightly down compared to her preoperative visit, her other symptoms were improving. Six months later her vision has returned to normal. Conclusions: Bilateral spontaneous CCF is a rare entity. Early diagnosis and treatment lead to successful outcomes. Neuro-radiological intervention is an effective treatment in acute setting.