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A carotid-cavernous sinus fistula is an anomalous communication of dural branches from the intracerebral artery or external carotid artery to the cavernous sinus. Spontaneous carotid-cavernous sinus fistulas have been associated with the presence of ruptured carotid aneurysms, atherosclerosis, diabetes mellitus, and genetic disorders such as Ehlers-Danlos syndrome or fibromuscular dysplasia. However, bilateral spontaneous carotid-cavernous sinus fistulas are still considered uncommon.1,2
Amorim E, Jankowitz BT, Jovin TG, Jadhav AP. Recovery From Ophthalmoplegia and Proptosis After Repair of Bilateral Carotid-Cavernous Sinus Fistulas. JAMA Neurol. 2013;70(12):1584-1585. doi:10.1001/jamaneurol.2013.1515