Physiological Considerations in the Treatment of Pulsating Exophthalmos

Carotid-Cavernous Fistula

“…One, a traumatic case, had a fatal epistaxis six weeks later, when the internal carotid aneurysm ruptured into the sphenoidal air sinus (Cairns, 1942); the other, a case of spontaneous fistula, died from subarachnoid haemorrhage after 18 months. Dorrance and Loudenslager (1934) noted also that the cases occurring spontaneously usually suffered from advanced arterial disease and debilitating conditions common to those of advanced years; hence the higher mortality of either conservative or operative treatment in this group.…”

“…This was done by Locke (1924), who considered all cases (588) on record up to that time, and was especially concerned with treatment. The catalogue was revised by Martin and Mabon (1943), who added 188 cases, and there have been many other writings on the subject, notably by Dorrance and Loudenslager (1934), Dandy (1937), Sugar and Meyer (1940), Holman et al (1951), andHamby (1952). " Pulsating exophthalmos " is not, however, synonymous with carotid-cavernous fistula, for about half the spontaneous cases of the former condition are due to other lesions involving the orbit, such as a vascular neoplasm, simple aneurysm, and encephalocele.…”

“…Further, as Dorrance and Loudenslager (1934) point out, " the multiplicity of procedures used in most cases renders it almost impossible to present adequate conclusions in' the form of a table." This is certainly true of the small series from which the cases already described were taken; and, in addition, two patients who were " cured " by internal carotid ligation died subsequently from haemorrhage.…”

Endoscopic endonasal transsphenoidal direct access and Onyx embolization of a dural arteriovenous fistula mimicking a carotid-cavernous fistula: case report

“…2 Historically, CCFs were treated with either sacrifice of the offending carotid artery or surgical packing of the cavernous sinus. 3 The modern treatment focuses on occlusion of the cavernous sinus through endovascular approaches, usually through a transvenous route. 4,5 Similarly, the treatment for dAVFs is obliteration of the fistulous connection point and proximal venous drainage, either surgically or through an endovascular approach.…”