Abstract
Background Carotid cavernous sinus fistulas (CSCF) are pathological connections of the internal
and/or external carotid artery (and/or its branches) to the cavernous sinus. Ophthalmological
symptoms and problems occur particularly when drainage is via the superior ophthalmic
vein.
Material and Methods Seven eyes of six patients with a high-grade suspicion of CSCF were included in this
retrospective monocentric study. Digital subtraction angiography (DSA) was performed
in the included patients, where an interventional fistula closure was performed in
the case of CSCF. Four of the six patients received a pre- and post-interventional
day-night intraocular pressure profile. Furthermore, medical history, symptoms, visual
acuity, slit lamp microscopic findings, and DSA findings were evaluated.
Results The most common symptoms reported by patients were red eyes, diplopia, and exophthalmos.
When the intraocular pressure (IOP) was measured, 83.33% of the patients showed increased
values. The mean IOP in the day-night intraocular pressure profile in the affected
eye before intervention was 23.5 (± 2.7) mmHg compared to 14.1 (± 2.3) mmHg in the
healthy eye. A significant difference could thus be demonstrated in side comparison
(p = 0.0047). The post-interventional measurement showed a mean IOP of 15.3 (± 1.0)
mmHg in the affected eye and thus a significant difference to the pre-interventional
measurement in the affected eye (p = 0.0018). Four of the six patients with CSCF were
taking antiglaucomatous eye drops before the intervention, and two patients after
the intervention. The number of antiglaucoma drugs used could also be reduced.
Conclusion Interventional fistula closure is an effective method for treating the secondary
increase of IOP in CSCF. Successful closure of the fistula showed a significant reduction
in IOP, which was not possible with the sole administration of antiglaucoma drugs.
Radius-Maumenee syndrome should be considered as a differential diagnosis.
Key words
cavernous sinus fistula - secondary open-angle glaucoma - Radius Maumenee syndrome
