Secondary Logo

Institutional members access full text with Ovid®

Share this article on:

Delayed Onset Cranial Nerve Palsies After Endovascular Coil Embolization of Direct Carotid-Cavernous Fistulas

Bou Ghannam, Alaa, MD; Subramanian, Prem, S., MD, PhD

Journal of Neuro-Ophthalmology: June 2018 - Volume 38 - Issue 2 - p 156–159
doi: 10.1097/WNO.0000000000000568
Original Contribution

Background: Late recurrence of visual symptoms associated with carotid-cavernous fistula (CCF), including diplopia, is uncommon and raises concern for new or recurrent fistula formation.

Methods: We report 2 patients with traumatic CCFs, where cranial nerve paresis resolved after endovascular CCF treatment only to reappear years later.

Results: No evidence of recurrent or new fistula formation was found. Both were treated successfully with strabismus surgery.

Conclusions: Although the cause of delayed onset diplopia after successful treatment is still unknown, theories include late compression of cranial nerves within the cavernous sinus due to coil mass that can cause chronic ischemia, delayed inflammation due to a thrombophilic nidus created by the coil mass, or injury to the cranial nerves that manifests later due to decompensated strabismus.

Departments of Ophthalmology, Neurology, and Neurosurgery (ABG, PSS), University of Colorado School of Medicine, Aurora, Colorado.

Address correspondence to Prem S. Subramanian, MD, PhD, University of Colorado School of Medicine, Anschutz Medical Campus, 1675 Aurora Court, Mailstop F-731 Aurora, CO 80045; E-mail:

Supported in part by a challenge grant to the Department of Ophthalmology from Research to Prevent Blindness, USA.

The authors report no conflicts of interest.

© 2018 by North American Neuro-Ophthalmology Society