Venous Drainage Patterns in Carotid Cavernous Fistulas
Figure 4
DSA views ((a), (b), (c), and (d)) of a 34-year-old male patient show a left sided, slow flow, indirect, mixed, Type D CCF. No underlying reason found for the fistula. The CCF (arrow in (a)) is fed by branches of both ICA and ECA with drainage via superior ophthalmic vein (SOV) (c) and (d)). Selective ICA catheterization (b) shows the filling of anterior aspect of the left cavernous sinus from the ophthalmic artery (arrowhead). The stenosis at the proximal aspect of the ophthalmic artery (arrow in (b)) suggests the presence of fistula for a long period of time. Selective ECA catheterization (c) and magnification (d) show filling of the fistula mainly from the foramen rotundum (fr) branch of internal maxillary artery (IMA) and minimally from accessory meningeal artery (ama). Corneal blushing is demonstrated (small white arrow in (c)). sta in (c): superficial temporal artery; stars (*) in (c) and (d): middle meningeal artery branches; black arrowheads in (c) and (d): infraorbital branch of IMA.
