Carotid Cavernous Fistula Presenting with Vision Loss

Carotid cavernous fistulas (CCFs) are often a result of trauma, cavernous carotid artery aneurysm rupture, or arteriovenous fistulae. Although a proportion can be managed expectantly, CCFs that are under high flow can lead to rapid neurologic deterioration or visual loss requiring expeditious diagnosis and management. This chapter presents the case of a female patient who presented with subacute vision loss, chemosis, and proptosis and was treated for bilateral CCF using endovascular embolization. A strong understanding of the pathology and meticulous endovascular technique are necessary in deciding which endovascular approach and embolization agents to use in obliterating the fistula. Both transvenous and transarterial routes may be used. Legacy open intracranial methods exist for treating CCF, but are rarely needed now.