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Carotid-cavernous fistulas

Jeffrey L Bennett, MD, PhD
Mithra O Gonzalez, MD
Section Editors
Paul W Brazis, MD
Jose Biller, MD, FACP, FAAN, FAHA
Deputy Editor
Janet L Wilterdink, MD


Acquired rather than congenital vascular malformations, carotid-cavernous fistulas (CCFs) may arise spontaneously or from secondary causes. CCFs can present with a variety of signs and symptoms. Many lesions are associated with significant neuro-ophthalmologic morbidity and mortality. Treatment decisions require multiple considerations: the nature of the symptoms, the location of the lesion, the complexity of the angioarchitecture, and the risk of visual and neurologic morbidity.

This topic discusses the pathogenesis, clinical presentation, diagnosis, and management of CCFs. Other vascular malformations of the central nervous system are discussed separately. (See "Brain arteriovenous malformations" and "Vascular malformations of the central nervous system".)


CCFs arise from abnormal communications between the carotid arteries and the cavernous sinus.

CCFs may be high- or low-flow lesions:

High-flow CCFs result from a direct connection between the intracavernous carotid artery and the surrounding cavernous sinus.

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Literature review current through: Oct 2017. | This topic last updated: Jun 19, 2017.
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