Direct and Dural Carotid Cavernous Sinus Fistulas: Comparison of Clinical Characteristics

Figures & data

Table 1 Demographic Characteristics of the Patients with CCFs

Variables	Direct CCFs (n = 28)	Dural CCFs (n = 32)	Total (n = 60)
Age (years), Mean ± SD (95% CI)	31.32 ± 13.52 (26.08, 36.56)	61.25 ± 9.94 (56.67, 64.83)	47.28 ± 19.03 (42.37, 52.19)
Gender N (%)
Female	12 (42.9)	23 (71.9)	35 (58.33)
Male	16 (57.1)	9 (28.1)	25 (41.67)
Duration (months) Mean ± SD (95% CI)	2.29 ± 2.69 (1.26, 3.34)	2.38 ± 2.19 (1.56, 3.19)	2.34 ± 2.42 (1.70, 2.97)
Trauma N (%)
Yes	26 (92.9)	5 (15.6)	31 (51.67)
No	2 (7.1)	27 (84.4)	29 (48.33)
Underlying diseases N (%)
No	25 (89.29)	15 (46.88)	40 (66.67)
DM	1 (3.6)	10 (31.3)	11 (18.33)
HT	2 (7.1)	11 (34.4)	13 (21.67)
DLP	0 (0.0)	5 (15.6)	5 (8.33)
Other	1 (3.6)	5 (15.6)	6 (10.00)
VA (logMAR) Mean ± SD (95% CI)	1.04 ± 1.05 (0.63–1.44)	0.42 ± 0.55 (0.22–0.61)	0.71 ± 0.87 (0.48, 0.93)
IOP (mmHg) Mean ± SD (95% CI)	22.93 ± 8.18 (19.76, 26.09)	21.69 ± 8.79 (18.52, 24.86)	22.27 ± 8.46 (20.08, 24.45)

Abbreviations: CCFs, carotid cavernous sinus fistulas; DM, diabetes mellitus; HT, systemic hypertension; DLP, dyslipidemia; VA, visual acuity; logMAR, logarithm of the minimum angle of resolution; IOP, intraocular pressure.

Table 2 Ocular Manifestations of the Patients with CCFs

Variables	Direct CCFs (n = 28)	Dural CCFs (n = 32)	Total (n = 60)
Blurred vision	17 (60.7)	12 (37.5)	29 (48.33)
Diplopia	5 (17.9)	7 (21.9)	12 (20.0)
Pain	14 (50.0)	13 (40.6)	27 (45.0)
External ophthalmoplegia	20 (71.4)	20 (62.5)	40 (66.67)
Proptosis	24 (85.7)	20 (62.5)	44 (73.33)
Bruit	19 (67.9)	4 (12.5)	23 (38.33)
Dilated episcleral vessels	27 (96.4)	30 (93.8)	57 (95.0)
Chemosis	18 (64.3)	9 (28.1)	27 (45.0)
Ptosis	2 (7.1)	2 (6.3)	4 (6.67)
Blood in Schlemm canal	7 (25.0)	5 (15.6)	12 (20.0)
Dilated retinal veins	12 (42.9)	4 (12.5)	16 (26.67)
Disc swelling	4 (14.3)	2 (6.3)	6 (10.0)
Intraretinal hemorrhage	3 (10.7)	2 (6.3)	5 (8.33)

Abbreviation: CCFs, carotid cavernous sinus fistulas.

Table 3 Mean IOP of Affected and Unaffected Eyes in Patients with Direct and Dural CCFs

CCF	Affected Eyes	Unaffected Eyes	Mean Difference	P value*
	Mean ± SD (95% CI)	Mean ± SD (95% CI)	Mean ± SD (95% CI)
Direct (28)	22.93 ± 8.18 (19.76, 26.09)	14.96 ± 4.13 (13.36, 16.57)	7.96 ± 7.09 (5.22, 10.71)	<0.001
Dural (32)	21.69 ± 8.79 (18.52, 24.86)	15.5 ± 5.91 (13.37, 17.63)	6.19 ± 6.89 (3.70, 8.67)	<0.001
Total (60)	22.27 ± 8.46 (20.08, 24.45)	15.25 ± 5.12 (13.93, 16.57)	7.02 ± 6.98 (5.21, 8.82)	<0.001

Note: *Paired t-test.

Abbreviation: CCFs, carotid cavernous sinus fistulas.

Table 4 Mean IOP of Affected Eyes in Increased IOP and Normal IOP Subgroups

CCF	Increased IOP	Normal IOP	Mean Difference	P value*
	Mean ± SD (95% CI)	Mean ± SD (95% CI)	Mean ± SD (95% CI)
Direct (28)	28.07 ± 7.55 (23.88, 32.25)	17 ± 3.58 (14.84, 19.16)	11.07 (6.35, 15.78)	<0.001
Dural (32)	28.73 ± 6.68 (25.03, 32.43)	15.47 ± 4.79 (13.00, 17.94)	13.26 (9.10, 17.43)	<0.001
Total (60)	28.4 ± 7.02 (25.78, 31.02)	16.13 ± 4.31 (14.52, 17.74)	12.27 (9.26, 15.28)	<0.001

Note: *Two-sample independent t-test.

Abbreviation: CCFs, carotid cavernous sinus fistulas.

Table 5 Mean IOP of Affected and Unaffected Eyes in Increased IOP and Normal IOP Subgroups

CCF Subgroup	Affected Eyes	Unaffected Eyes	Mean Difference	P value*
	Mean ± SD (95% CI)	Mean ± SD (95% CI)	Mean ± SD (95% CI)
Increased IOP (30)	28.4 ± 7.02 (25.78, 31.02)	17 ± 5.84 (14.82, 19.18)	11.4 ± 6.33 (9.04, 13.76)	<0.001
Normal IOP (30)	16.13 ± 4.31 (14.52, 17.74)	13.5 ± 3.59 (12.16, 14.84)	2.63 ± 4.41 (0.99, 4.28)	0.003
Total (60)	22.27 ± 8.46 (20.08, 24.45)	15.25 ± 5.12 (13.93, 16.57)	7.02 ± 6.98 (5.21, 8.82)	<0.001

Note: *Paired t-test.

Abbreviation: CCFs, carotid cavernous sinus fistulas.

Table 6 Logistic Regression Analysis of Clinical Characteristics of CCF Patients

Variables	Direct CCF (n = 28)	Dural CCFs (n = 32)	OR (95% CI)	P value
Age (years) mean ± SD	31.32 ± 13.52	61.25 ± 9.94	1.21 (1.09, 1.33)	<0.001
VA (logMAR) mean ± SD	1.04 ± 1.05	0.42 ± 0.55	2.75 (1.22, 6.20)	0.015
IOP (mmHg) mean ± SD	22.93 ± 8.18	21.69 ± 8.79	1.02 (0.96, 1.08)	0.569
Female	12 (42.9)	23 (71.9)	3.45 (1.16, 9.98)	0.025
Trauma	26 (92.9)	5 (15.6)	70.2 (12.5, 394.39)	<0.001
Underlying diseases	3 (10.71)	17 (53.13)	9.44 (2.37, 37.7)	0.001
Diplopia	5 (17.9)	7 (21.9)	1.29 (0.36, 4.63)	0.698
Blurred vision	17 (60.7)	12 (37.5)	2.58 (0.91, 7.31)	0.075
Orbital pain	14 (50.0)	13 (40.6)	1.46 (0.53, 4.07)	0.467
External ophthalmoplegia	20 (71.4)	20 (62.5)	1.5 (0.51, 4.45)	0.465
Proptosis	24 (85.7)	20 (62.5)	3.3 (0.91, 11.98)	0.069
Orbital bruits	19 (67.9)	4 (12.5)	14.78 (3.97, 54.99)	<0.001
Dilated episcleral vessels	27 (96.4)	30 (93.8)	1.8 (0.15, 20.99)	0.639
Chemosis	18 (64.3)	9 (28.1)	4.6 (1.54, 13.70)	0.006
Ptosis	2 (7.1)	2 (6.3)	1.15 (0.15, 8.78)	0.890
Blood in Schlemm’s canal	7 (25.0)	5 (15.6)	3.52 (0.76, 16.39)	0.109
Dilated retinal veins	12 (42.9)	4 (12.5)	5.2 (1.42, 19.04)	0.013
Disc swelling	4 (14.3)	2 (6.3)	2.43 (0.41, 14.51)	0.328
Intraretinal hemorrhage	3 (10.7)	2 (6.3)	1.75 (0.27, 11.36)	0.59

Abbreviations: CCFs, carotid cavernous sinus fistulas; VA, visual acuity; logMAR, logarithm of the minimum angle of resolution; IOP, intraocular pressure; OR, odds ratio; CI, confidence interval.