Successful Outcome of External Manual Carotid Compression in a Case of Indirect Carotid Cavernous Fistula

抄録

Introduction: Carotid cavernous fistula（CCF）is a rare condition that refers to an abnormal connection between the cavernous sinus and carotid arteries. Indirect CCF mostly occurs in older female patients and can resolve spontaneously. External manual carotid compression（EMCC）is used for the conservative management in CCF, particularly indirect CCF.

Case Report: A 61-year-old female patient presented with proptosis, lagophthalmos, episcleral injection, pain, headache, redness of the left eye, and ophthalmoplegia since 2 weeks before admission. She was hypertensive without any history of trauma. Her left visual acuity on the Snellen chart was 0.3, with unremarkable contrast and color sensitivity. She had a corkscrew appearance on the conjunctiva and Grade I left relative afferent pupillary defect. Funduscopy examination revealed tortuosity of the blood vessels with optic disc swelling. Computed tomography angiography showed a type B CCF according to the Barrow Classification. Digital subtraction angiography（DSA）was planned, and the patient was instructed to perform EMCC while waiting for DSA. After 2 months, her condition improved.

Conclusion: Indirect-type CCF can occur spontaneously and can be a sight-threatening condition. Indirect CCF can spontaneously resolve with EMCC.