Venous Drainage Patterns in Carotid Cavernous Fistulas
Figure 3
Bilateral CCFs are shown in a 50-year-old female subject with no history of trauma or aneurysm. In (a), a right sided slow flow indirect Type B CCF is filling from dural branches of right ICA with only drainage via IPS. No filling noted during selective right ECA catheterization (not shown here). In ((b), (c), and (d)), a left sided slow flow indirect Type C CCF is filling mainly from foramen rotundum (fr) and pterygovaginal (pv) branches of internal maxillary artery (IMA) and partly from the accessory meningeal artery (ama). Selective IMA catheterization (d) demonstrates the fistula better. Major drainage is toward anterior via the superior ophthalmic vein (arrowheads in (b), (c), and (d)) and minor drainage toward contralateral via intercavernous connections (small arrow in (c)). CS: cavernous sinus, IPS: inferior petrosal sinus, io: infraorbital branch of IMA.
