Carotid Cavernous Fistulas

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Houston Methodist’s internationally recognized neurologists offer advanced diagnosis and personalized treatment for carotid-cavernous sinus fistulas.

The interdisciplinary team at Houston Methodist provides nationally recognized expertise and personalized care for patients with carotid-cavernous sinus fistulas (CCF). These rare, abnormal connections between the arteries in the neck and veins behind the eyes require precise diagnosis for safe effective treatment. 

While some CCFs recur, most patients fully recover. Many patients find symptom relief within hours to days of treatment under our expert care.

Diagnosing & Treating Carotid-Cavernous Fistulas

How are carotid-cavernous fistulas diagnosed?

A CCF can raise the pressure in the cavernous sinus and affect nearby nerves that control eye movements and some sensations in parts of the head and face. It can also affect the veins that drain the eyes. CCFs are one of the causes of “red eye” and other visual problems.  

If left untreated, vision loss can occur. Other symptoms can include: 

  • Conjunctivitis (pink eye) symptoms 
  • Hearing a rumbling, buzzing or swishing sound, known as a bruit 
  • Double vision 
  • Eye pain or pressure
  • Red or bulging eye (proptosis) that may pulse 

After a discussion about your symptoms and medical history, your neurologist will perform a physical exam and an eye exam. Other imaging scans that evaluate your eye, nearby blood vessels and cavernous sinus area include: 

  • Computerized tomography (CT) scan 
  • Magnetic resonance imaging (MRI) 
  • Ultrasound 

Based on the results of your exams, we will determine whether your CCF is one of two types: 

There are two types of carotid-cavernous sinus fistulas: 


  • Direct, which usually results from a torn carotid artery. This type is often caused by head trauma. Between 70 and 90% of direct CCFs are caused by injury to the base of the skull. 
  • Indirect, which can occur spontaneously, due to a connective tissue disorder or as a result of a ruptured aneurysm or atherosclerotic arteries. Indirect CCFs occur more often in postmenopausal women who have high blood pressure. 

What treatments are available?

When a CCF causes severe or worsening symptoms, endovascular embolization can provide relief. In this procedure, a specialist inserts a tiny catheter into an artery in the groin and guides it to the fistula. Platinum coils or other materials inserted through the catheter can be used to block abnormal blood flow between the artery and vein. 

Medications may also be prescribed to lubricate the eye or reduce eye pressure.

What if I need advanced care or a second opinion? 

Whether you need a precise diagnosis or a second opinion, we can help. Our specialists can pinpoint the cause of your symptoms and design a personalized treatment plan to restore your quality of life.

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