Carotid cavernous fistula. History and anatomy

  • D. Parkinson


The parasellar compartment commonly known as the “cavernous sinus” contains a more compact complexity of gross anatomy than any other structure, a veritable anatomic jewel box. The orbit, a much larger cavity, would be its closest rival. The orbit literature fills many library shelves whereas its poorer back door neighbour barely rates and address in the library catalogue. Its printed papers over the centuries would fill no more than one small text. The discrepancy reflects the relative visibility, accessibility, and number of clinical syndromes involved. Virtually all disturbances of the “cavernous sinus” are manifested first and foremost by its prominent front door neighbour the orbit and hence described under such titles. We can be reasonably certain that the classical syndrome resulting from the carotid cavernous fistula (CCF) was noticed long before first described by Bartholow [4]. “Evil Eye Fleegle” of comic book fame [17] was unlikely the first to inspire belief that the owner of a pulsating, protruding, engorged eye (or eyes) possessed supernatural powers, evil or otherwise.


Internal Carotid Artery Cranial Nerve Circulatory Arrest Ophthalmic Artery Venous Canal 
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  1. 1.
    Adson AW (1942) Surgical treatment of vascular diseases altering the function of the eyes. J Am Acad Ophthalmol 46: 95–111Google Scholar
  2. 2.
    Alksne JF, Fingerhut AG, R and RW (1966) Magnetically controlled focal intra-vascular thrombosis in dogs. JNS 25: 516Google Scholar
  3. 3.
    Baker MA, Hayward JN (1967) Carotid rete and brain temperature in the cat. Nature 216: 139–141PubMedCrossRefGoogle Scholar
  4. 4.
    Bartholow R (1872) Aneurysms of the arteries of the base of the brain—their symptomatology diagnosis and treatment. Ann J Med Sci 64: 375–386Google Scholar
  5. 5.
    Bedford MA (1966) Cavernous sinus. Br J Ophthalmol 52: 41–46CrossRefGoogle Scholar
  6. 6.
    Bergland MA, Ray BS, Tarack RM (1968) Anatomic deviations in the pituitary gland and adjacent strictures in 225 human autopsy cases. JNS 28: 93–99Google Scholar
  7. 7.
    Bernasconi V, Casserini V (1957) Caratteristiche angiografiche dei menin- geomi del tentorio. Radiol Med 43: 1015–1026PubMedGoogle Scholar
  8. 8.
    Berquist E, Willen R (1974) Cavernous nodules in the dural sinuses. JNS 40: 330–335Google Scholar
  9. 9.
    Birley JL, Trotter W (1918) Traumatic aneurysm of the intracranial portion of the internal carotid artery. Brain 51: 184–208CrossRefGoogle Scholar
  10. 10.
    Blackman GC (1848) Ligature of both primitive carotids. Am J Med Sci 75: 357–359Google Scholar
  11. 11.
    Bol’Shakow OP (1964) Macroscopical structural of the cavernous sinus. Fed Proc [Transl Suppl] 23: 308Google Scholar
  12. 12.
    Bonnet P (1953) Physiologie pathologique de l’exophthalmos pulsatile. Arch Ophthalmol 13: 233–251Google Scholar
  13. 13.
    Brainerd P (1985) A case of erectile tumor of the orbit: cured by infiltration of lactate of ion and puncture with hot needles after carotid ligation had failed. Lancet 2: 162–164Google Scholar
  14. 14.
    Brihaye J (1976) Pathogenesis and symptomatology of the carotid cavernous fistula. Third postgraduate course in neurosurgery. Pécs, July 1976Google Scholar
  15. 15.
    Brooks B (1931) Discussion Noland L and Taylor AS. J S Surg 43: 176–177Google Scholar
  16. 16.
    Browder J (1937) Treatment of carotid artery cavernous sinus fistula. Arch Ophthalmol 18: 95–102Google Scholar
  17. 17.
    Capp Al (1965) Personal communicationGoogle Scholar
  18. 18.
    Cooper A (1908) A second case of carotid aneurysm. J Med Chir Soc Edinburg 1: 222Google Scholar
  19. 19.
    Cunningham DHJ, Romanes GJ (ed) (1981) Textbook of anatomy, 12th edn. Oxford University Press, London, p 907–909Google Scholar
  20. 20.
    Cunningham DHJ, Brash JC (ed) (1956) Textbook of anatomy, 9th edn. Oxford University Press, London, p 824Google Scholar
  21. 21.
    Cushing H (1905) The special field of neurological surgery. Bull Johns Hopkins Hospital 16: 168Google Scholar
  22. 22.
    Cushing H (1911) The control of bleeding in operations for brain tumors. Ann Surg 54: 1–19PubMedCrossRefGoogle Scholar
  23. 23.
    Cushing H (1931) Electrosurgery as an aid to the removal of intra-cranial surgery. SGO 52: 129Google Scholar
  24. 24.
    Dandy WE (1935) The treatment of carotid cavernous a.v. aneurysms. Ann Surg 102: 916–210PubMedCrossRefGoogle Scholar
  25. 25.
    Delens E (1870) De la communication de la carotide interne et du sinus caverneux. Thesis, ParisGoogle Scholar
  26. 26.
    Dolenc Y (1983) Direct neurological repair of intra cavernous vascular lesions. JNS 58: 824–884Google Scholar
  27. 27.
    Dolenc V (1986) Presentations int symp on CS. June 1986, Ljubljana, YugoslaviaGoogle Scholar
  28. 28.
    Dorrance GM, Loudenslager PE (1934) Physiologic considerations in treatment of pulsating exophthalmos. Ann J Ophthalmol 17: 1099–1111Google Scholar
  29. 29.
    Dott NMc (1969) Congress of neurosurgery. MontrealGoogle Scholar
  30. 30.
    Elschnig A (1893) Arch F Ophthalmol 39: 151–177. Quoted by Hamby WB [39]CrossRefGoogle Scholar
  31. 31.
    Fujii K, Chambers SM, Rhoton (1979) Neurovascular relationship of the sphenoid sinus, a microsurgical study. JNS 50: 31–39Google Scholar
  32. 32.
    Galen C, quoted in: Margotta R, Limes P (eds) (1968) An illustrated history of medicine. Hamlen Publishing, Feltham, Middlesex, p 96Google Scholar
  33. 33.
    Gigli L (1898) Zur Technik der temporalen Schädelresektion mit einer Drahtsäge. Centralbl Chir 25: 245Google Scholar
  34. 34.
    Goshal NG (1986) Dural sinuses in the pig and their extra cranial venous connections. Am J Vet Res 47: 1165–1169Google Scholar
  35. 35.
    Goshal NG, Khamas WM (1985) Gross and histomorphological study on the tostral epidural rete mirable of the pig. Int J Anim Sci 55: 304–310Google Scholar
  36. 36.
    Goshal NG (1985) Thermo regulatory role of the cranial circulation in cerebral temperature control. Vlaam Diergeneeskungid Tijdschrift 54: 246–261Google Scholar
  37. 37.
    Goshal NG (1986–87) Personal communicationGoogle Scholar
  38. 38.
    Graf CJ, Hamby WB (1966) Personal communicationGoogle Scholar
  39. 39.
    Hamby WB (1966) Carotid cavernous fistula. ChC Thomas Publishers, Springfield, IllinoisGoogle Scholar
  40. 40.
    Hamby WB, Gardner WJ (1933) Treatment of pulsations exophthalmos with report of two cases. Arch Surg 27: 676–685Google Scholar
  41. 41.
    Hamby WB (1963–1973) Personal communicationGoogle Scholar
  42. 42.
    Hamby WB, Dohn DF (1964) Carotid cavernous fistula: report of 36 cases and discussion of their management. Clin Neurosurg 11: 150–170PubMedGoogle Scholar
  43. 43.
    Harrison CR, Hearn JB (1961) A new aspect of collateral circulation of internal carotid artery. JNS 18: 542–545Google Scholar
  44. 44.
    Hayes GJ (1985) Carotid cavernous fistulas: diagnosis and surgical management. Ann Surg 24: 839Google Scholar
  45. 45.
    Hollinshead WH (1954) Anatomy for surgeons, vol 1. Haeber Harper, New York, p560Google Scholar
  46. 46.
    Holman E (1923) Physiology of an anteriovenous fistula. Arch Surg 7: 64–82Google Scholar
  47. 47.
    Horsley V (1887) Remarks on ten consecutive cases of operation on the brain and cranial cavity to illustrate the details and safety of the method employed. Br Med J, Apr 16: 862Google Scholar
  48. 48.
    Hamby WB (1968) Personal communicationGoogle Scholar
  49. 49.
    Hunter WM (1762) Further observations upon a certain species of aneurysm. Observ Enqui 2: 390–414Google Scholar
  50. 50.
    Isamat F, Salleras V, Miranda AM (1970) Artificial embolization of CCF with post operative patency of internal carotid artery. J Neurol Neurosurg Psychiatry 33: 674–678PubMedCrossRefGoogle Scholar
  51. 51.
    Jaeger R (1949) Intracranial aneurysms. South Surg 15: 205–217PubMedGoogle Scholar
  52. 52.
    Jefferson G (1938) The vascular aneurysms of the internal carotid artery in the cavernous sinus. Br J Surg 26: 267–302CrossRefGoogle Scholar
  53. 53.
    Johnson JH, Parkinson D (1974) Intracranial sympathetic pathways associated with the sixth nerve. J Neurosurg 40: 236–243CrossRefGoogle Scholar
  54. 54.
    Jones RR, Weitzel H (1970) Bilateral carotid vertebro basilar rete mirable. JNS 33: 581–586Google Scholar
  55. 55.
    Kocher T, Richardson RG (ed) (1968) Surgery old and new frontiers. Ch Scribner’s Sons, New York, p 126Google Scholar
  56. 56.
    Krayenbühl HD (1967) Unilateral exophthalmos. Clin Neurosurg 19: 289–301CrossRefGoogle Scholar
  57. 57.
    Kubic S, Youmans JR (eds) (1982) Neurosurgical surgery, vol 5. Saunders, Toronto, p 3112Google Scholar
  58. 58.
    Hamby WB (1965) Personal communicationGoogle Scholar
  59. 59.
    MacEwen W (1881) Tumor of the dura mater. Lancet 2: 581CrossRefGoogle Scholar
  60. 60.
    McConnell EM (1953) The arterial blood supply of the human hypophysis cerebri. Anat Rec 15: 175–203CrossRefGoogle Scholar
  61. 61.
    Mahoney GCG de, Schachter MH (1972) The myth of the rete mirable in man. Neuroradiology 4: 141–158CrossRefGoogle Scholar
  62. 62.
    Malpighi M (1686) De pulmonibus in opuscula anatomia, Balogna 1680. Opera omnia. R Scott, London, 2 volsGoogle Scholar
  63. 63.
    Margotta R, Limes P (eds) (1968) An illustrated history of medicine. Hamlin Publishing, Feltham, Middlesex, p 96Google Scholar
  64. 64.
    Manti-Albanez (1971) A tale of tubes. Canada, 12: 133–141Google Scholar
  65. 65.
    Moniz E (1928) La radioanteriographie et la topographie cranioencéphalique. J RadioElectrol 121: 1Google Scholar
  66. 66.
    Monro A (1746) The anatomy of the humor bones and nerves. Hamilton & Balfour, Edinburgh, p 363Google Scholar
  67. 67.
    Mont RR, in discussion of Dandy WE [24]Google Scholar
  68. 68.
    Mullan, quoted by Peterson E [101]Google Scholar
  69. 69.
    Nafziger H, in discussion of Dandy WE [24]Google Scholar
  70. 70.
    Nelaton H (1873) Carotid cavernous fistula. Lancet (Holmes lecture) 2: 142Google Scholar
  71. 71.
    Nishimato A, Takewchia S (1968) Abnormal network related to the internal carotid artery. JNS 29: 256–260Google Scholar
  72. 72.
    Obrador S (1974) Spontaneous CCF produced by rupture of aneurysm of meningo hypophyseal branch of internal carotid artery. JNS 40: 539–543Google Scholar
  73. 73.
    Paget DH (1948) The development of the cranial arteries in the human embryo. Contrib Embryol 32: 205–262Google Scholar
  74. 74.
    Paget DH (1961) Personal communicationGoogle Scholar
  75. 75.
    Pare A, Keyres G (eds) (1968) The apologies and treatise containing the voyages made into diverse places with many of his writings upon surgery. Dover Publications, New York, p 19Google Scholar
  76. 76.
    Parkinson D, Ramsay RM (1963) Carotid cavernous fistula with pulsating exophthalmus: a fortuitous care. Can J Surg 6: 191–195PubMedGoogle Scholar
  77. 77.
    Parkinson D (1964) Collateral circulation of cavernous carotid artery: anatomy. Can J Surg 7: 251–268PubMedGoogle Scholar
  78. 78.
    Parkinson D (1965) A surgical approach to the cavernous portion of the carotid artery. Anatomical studies and case report. J Neurosurg 23: 474–483PubMedCrossRefGoogle Scholar
  79. 79.
    Parkinson D, MacPherson RA, Childe AE, Middlecote LR, Morrow IM, MacEwan DW (1967) Routine simultaneous biplane stereoscopic angiography. J Can Assoc Radiol 18: 371–376PubMedGoogle Scholar
  80. 80.
    Parkinson D (1969) Transcavernous repair of carotid cavernous fistula. J Neurosurg 26: 420–424Google Scholar
  81. 81.
    Parkinson D (1972) Carotid cavernous fistula. In: Yinken PJ, Bruyn GW (eds) Handbook of clinical neurology, vol 12. North Holland, Amsterdam, pp 267–288Google Scholar
  82. 82.
    Parkinson D (1972) Anatomy of the cavernous sinus. In: Smith JL (ed) Neurophthalmology, vol 6. CV Mosby Company, St. Louis, pp 73–101Google Scholar
  83. 83.
    Parkinson D (1973) Carotid cavernous fistula: direct repair with preservation of the carotid artery. J Neurosurg 38: 99–106PubMedCrossRefGoogle Scholar
  84. 84.
    Parkinson D, Shields CB (1974) Persistent trigeminal artery: its relationship to the normal branches of the cavernous carotid. J Neurosurg 40: 245–248Google Scholar
  85. 85.
    Parkinson D (1974) Rete mirabile, the marvellous network. Can J Neurol Sci 1: 121–123PubMedGoogle Scholar
  86. 86.
    Parkinson D (1974) Carotid cavernous fistula: direct repair with preservation of the carotid artery. Surg 76: 882–889Google Scholar
  87. 87.
    Parkinson D (1975) Editorial communication. Carotid cavernous fistula. J Neurosurg 42: 1, 119PubMedGoogle Scholar
  88. 88.
    Parkinson D (1976) Carotid cavernous fistula, direct approach with repair of fistula and preservation of the artery. In: Morley TP (ed) Current controversies in neurosurgery. Saunders, Philadelphia, pp 237–249Google Scholar
  89. 89.
    Parkinson D, Legal J, Holloway AF, Walton RJ, LaFrance RT, MacEwan DW, Johnston J (1978) A new combined neurosurgical headholder and cassette changer for intraoperative serial angiography. J Neurosurg 48: 1038–1041PubMedCrossRefGoogle Scholar
  90. 90.
    Parkinson D (1979) Anatomy of the cavernous sinus. In: Pia HW, Langmaid C, Zierski J (eds) Cerebral aneurysms. Springer Verlag, Berlin Heidelberg New York, pp 62–67Google Scholar
  91. 91.
    Parkinson D (1979) Intraoperative angiography. In: Pia HW, Langmaid C, Zierski J (eds) Cerebral aneurysms. Springer Verlag, Berlin Heidelberg New York, pp 181–184Google Scholar
  92. 92.
    Parkinson D (1979) Surgical approach to cavernous sinus aneurysms. In: Pia HW, Langmaid C, Zierski J (eds) Cerebral aneurysms. Springer Verlag, Berlin Heidelberg New York, pp 224–228Google Scholar
  93. 93.
    Parkinson D (1980) Venous anatomy of the cavernous sinus. In: Williams PL, Warwick R (eds) Gray’s anatomy. Churchill Livingstone, Edinburgh, p 751Google Scholar
  94. 94.
    Parkinson D, West M (1982) Lesions of the cavernous plexus region. In: Youmans JR (ed) Neurological surgery, vol 5. Saunders, Philadelphia, pp 3004–3024Google Scholar
  95. 95.
    Parkinson D (1981) Surgical management of internal carotid artery aneurysms within the cavernous sinus. In: Schmidek HH, Sweet WH (eds) Operative neurosurgical techniques, vol 2. Grune & Stratton, New York, pp 819–829Google Scholar
  96. 96.
    Parkinson D, Wilkins RH, Rengachary SS (eds) (1985) Anatomy of the cavernous sinus in neurosurgery, vol 2. McGraw-Hill, New York, pp 1473–1483Google Scholar
  97. 97.
    Parkinson D (1957) Internal carotid insufficiency, a useful physical sign. CMAJ 76: 488–489Google Scholar
  98. 98.
    Parkinson D, Johnson J, Chaudhuri A (1978) Sympathetic connections of the fifth and sixth cranial nerves. Anat Rec 191: 221–226PubMedCrossRefGoogle Scholar
  99. 99.
    Parkinson D, Bernard M (1979) Horner syndrome and others. Surg Neurol 11: 221–223PubMedGoogle Scholar
  100. 100.
    Pernkoph E (1963) Atlas of topographic and applied human anatomy, vol 1. Saunders, Philadelphia, pp 65, 73, 75Google Scholar
  101. 101.
    Paget DH (1970) Personal communicationGoogle Scholar
  102. 102.
    Pool VL, Potts DC (1965) Aneurysms and anteriovenous anomolies of the brain. Harper and Row, New YorkGoogle Scholar
  103. 103.
    Power JH (1863) Anatomy of the arteries of the human body. JB Lippincott & Co, Philadelphia, p 130Google Scholar
  104. 104.
    Rhoton AL, Hardy DG, Chambers SM (1979) Micro surgical anatomy and dissection of the sphenoid bone, cavernous sinus and sella region. Surg Neurol 12: 63–104PubMedGoogle Scholar
  105. 105.
    Ridley H (1965) The anatomy of the brain. Smith and Walford, London, p 39Google Scholar
  106. 106.
    Sanders MD, Hoyt WF (1969) Hypoxic sequelae of CCF. Br J Ophthalmol 53: 82–97PubMedCrossRefGoogle Scholar
  107. 107.
    Schnitzlein F, Muntagh R, Arrington JA, Parkinson D (1985) The sinus of the Dorsum sellae. Anat Ree 213: 587–589CrossRefGoogle Scholar
  108. 108.
    Schnurer LB, Stattin S (1963) Vascular supply of intra cranial dura from internal carotid artery with special reference to its angiographic significance. Acta Radiol [Diagn] (Stockh) 1: 441–450Google Scholar
  109. 109.
    Paget DH (1965) Personal communicationGoogle Scholar
  110. 110.
    Seftel DL, Kalson H, Gordon BS (1959) Ruptured intra cavernous carotid aneurysm with fatal epistasis. Arch Otolaryngol 70: 52–60Google Scholar
  111. 111.
    Seljeskog EL (1973) Carotid cavernous fistula. Minnesota Med: 929–950Google Scholar
  112. 112.
    Serbinenko F (1970) Personal communication, MoscowGoogle Scholar
  113. 113.
    Singleton AO (1939) Intracranial arterio venous aneurysms. Ann Surg 110: 525PubMedCrossRefGoogle Scholar
  114. 114.
    Solasol A, Zidunc C, Slimanc-Taleb S et al (1966) The veins of the cavernous sinus in the four months old human fetus. CR Assoc Anat 149: 1009–1015Google Scholar
  115. 115.
    Spalteholz W (1935) Hand atlas of human anatomy, vol 2, 7th edn. JB Lippincott, Philadelphia, pp415, 459Google Scholar
  116. 116.
    Speakman TJ (1964) Internal occlusion of a carotid cavernous fistula. J Neurosurg 21: 303–305PubMedCrossRefGoogle Scholar
  117. 117.
    Sweet WH, Bennett HS (1948) Changes in internal carotid pressure during carotid and jugular occlusion and their clinical significance. JNS 5: 178–196Google Scholar
  118. 118.
    Thalamon J (1978) Volume neuroradiologic 14–2. Masson et cie Éditions, St. Germain Paris, p 333Google Scholar
  119. 119.
    Tandler J (1906) Zur Entwicklungsgeschichte der arteriellen Wundernetze. Anat Hefte 31: 235–265CrossRefGoogle Scholar
  120. 120.
    Taptas JN (1949) La loge du sinus caverneux rev. Atoneuraophthalmol 21: 193–199Google Scholar
  121. 121.
    Taveras JM, Mount LA, Friednberg RM (1954) Artériographie demon-stration of external carotid anastomosis through the ophthalmalous anterior. Radiology 63: 525–530PubMedGoogle Scholar
  122. 122.
    Taylor CR (1969) The eland and the oryx. Scientific American 220: 88–95PubMedCrossRefGoogle Scholar
  123. 123.
    Travers B (1811) A case of aneurysm of anastomosis in the orbit, by ligation of the common carotid artery. Med Clin Tr 2: 1–16Google Scholar
  124. 124.
    Twitchell A (1984) Gunshot wound of the face and neck. Ligation of the common carotid artery. N Engl J Med 1: 188–193Google Scholar
  125. 125.
    Umansky F, Nathan H (1982) The cavernous sinus with special reference to its lateral wall. JNS 56: 288–234Google Scholar
  126. 126.
    Uihlein A, Terry HR Jr, Payne WS, Kirklin JW (1962) Operations on intra cranial aneurysms with induced by hypothermia below 15 00B0C and total circulatory arrest. JNS 19: 237–239Google Scholar
  127. 127.
    Vesalius A, quoted in: Garrison FH (1966) History of median. Saunders, Philadelphia, p219Google Scholar
  128. 128.
    Wallace S, Goldberg GI, Leeds ME, Mishlin MM (1967) The cavernous branches of the internal carotid artery. Am J Roentgenol Radium Ther Nuc Med 1: 34–46Google Scholar
  129. 129.
    Winslow JB (1734) Exposition anatomique de la structure du corps humain, vol 2. Prevast, London, p 31Google Scholar
  130. 130.
    Zeal AA, Rhoton AL (1978) Microsurgical anatomy of posterior cerebral artery. JNS 48: 534–551Google Scholar

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© Springer-Verlag/Wien 1987

Authors and Affiliations

  • D. Parkinson
    • 1
  1. 1.University of ManitobaWinnipegCanada

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