• S Stéphan, R Blanc, M Zmuda, C Vignal, M Barral, S Pistocchi, M Piotin, and O Galatoire.
• Oculoplastic surgery department, Foundation Rothschild Hospital, 29, rue Manin, 75019 Paris, France. Electronic address: sofi.stephan@gmail.com.
• J Fr Ophtalmol. 2016 Jan 1; 39 (1): 74-81.

IntroductionCarotid-cavernous fistulae are rare and affect visual prognosis. Their clinical presentation is varied and delayed diagnosis is common. They require rapid neuro-radio-ophthalmologic management.PurposeThe goal of this study was to evaluate the long-term efficacy and prognostic factors for treatment of carotid-cavernous fistulas by embolization.Materials And MethodsA total of 60 patients with direct (10/60, 17%) or indirect (50/60, 83%) carotid-cavernous fistulae suspected during ophthalmological examination underwent cerebral angiography from December 2003 to October 2013. Of these, 59 (59/60, 98%) patients were treated with embolization. Treatment response was assessed with a follow-up angiogram confirming the exclusion of the fistula, and clinically by resolution of the initial symptoms.ResultsThe diagnosis was suspected on the basis of proptosis in 45 patients (45/60, 75%), corkscrew episcleral vessels in 38 patients (38/60, 63%), chemosis in 37 patients (37/60, 61%), and diplopia in 30 patients (30/60, 50%). The median delay in diagnosis was 5 ± 5 months [0.5 to 24 months], and mean follow-up was 31 ± 31.5 months [0.5-118 months]. Eighteen patients (18/60, 30%) were lost to follow-up. Clinical response was complete in 24 patients (24/42, 57%) and partial in 14 patients (14/42, 33.5%). Symptoms were stable in one patient (1/42, 2.5%) and worsened in 3 patients (3/42, 7%). Morbidity per procedure was 3.3% and there was no postoperative mortality. Forty patients (40/60, 67%) had radiological follow-up and 39 patients (39/40, 97.5%) had a complete exclusion of the fistula. The presence of diplopia on initial examination was more frequently associated with an incomplete cure (P=0.04).ConclusionThe combination of proptosis, corkscrew episcleral vessels and diplopia should rapidly lead to head imaging to search for a carotid-cavernous fistula. Fistula embolization is a safe and effective treatment. The presence of diplopia on initial examination may be associated with a poorer outcome (P=0.044).Copyright © 2015 Elsevier Masson SAS. All rights reserved.

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