Carotid-Cavernous Fistula

The cavernous sinus is a hollow area behind your eyes. Many blood vessels run through this area, including branches of your carotid artery – which deliver blood to your head and brain.

A carotid-cavernous fistula (CCF) happens when the carotid artery tears and then forms a new connection to the wrong blood vessel.



There are two kinds of carotid-cavernous fistulas (CCF): 

  • A direct CCF occurs when your carotid artery has reconnected to veins inside the cavernous sinus area, and most often happens after a head injury. 
  • An indirect CCF occurs when your carotid artery has reconnected to blood vessels inside your brain’s membrane. Conditions that weaken your blood vessels – like high blood pressure, a recent pregnancy or head surgery – can increase your risk for indirect CCF.

A carotid-cavernous fistula often affects the eyes. Symptoms include:

  • Redness or swelling in your eyes
  • Difficulty moving your eyes
  • Double vision
  • Blindness
  • Facial pain
  • Nosebleeds
  • Tinnitus (ringing in your ears) or a high-pitched humming sound in your head


If your doctor suspects a CCF, he or she may order an imaging test, such as an MRI, CT scan or one of these specialized tests:

  • Eye and orbit ultrasound (orbital echography): This type of ultrasound can produce detailed pictures of the blood vessels near your eyes.
  • Tonometry: For this test, you’ll be given numbing eye drops, then a small probe will be placed on the surface of your eye to measure the pressure inside.
  • Digital subtraction angiography (DSA): For this procedure, you’ll be injected with a dye, and an X-ray will be taken of your blood vessels. Then a computer digitally removes the unaffected blood vessels from the image to allow your doctor to see the fistula clearly.

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Treatment Options

Treatment depends on where your fistula is and how big it is. If yours is small, your doctor may suggest simply watching it to see if it closes on its own. 

If your CCF is large or causing symptoms, your doctor may recommend one of the following procedures to close the fistula:

  • Endovascular embolization: First, a catheter is put into an artery in your groin and guided up to the fistula. Next, a device – a small metal coil, balloon or medical foam – is put through the catheter and placed inside the fistula to permanently fill and seal the area.
  • Stereotactic radiosurgery: A high dose of radiation is directed at your affected blood vessels. This detaches them without affecting your artery. Aurora surgeons use an innovative form of this technique called CyberKnife® radiosurgery, a non-invasive, robotic system that delivers high radiation therapy to tumors with pinpoint accuracy.

You doctor may also prescribe medications to lubricate your eyes and reduce the fluid (intraocular) pressure, easing some of your symptoms.

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