The primary treatment is often endovascular because of the feasibility of catheterizing the lesion directly and placing embolic material directly at the site of the abnormal arteriovenous connection. Additionally, spinal lesions and lesions contained entirely in the extracranial space will be separately addressed, although many principles of the treatment of fistulae with cerebral components also apply to the treatment of all fistulae. Under normal circumstances, the CS contributes to cerebral venous drainage by receiving blood flow from the sphenoparietal sinus and from the orbit by way of the ophthalmic veins. Thus, venous drainage from the globe is directed toward the CS by way of the ophthalmic veins. Maintenance of normal intraocular pressure is a function of maintenance of normal venous pressure in the orbit, among other factors.
Venous congestion occurs in the territory drained by the ophthalmic veins.
The diagnosis of CCF can usually be made clinically. In the absence of a history of trauma, patients usually present because they have orbital complaints related to increased venous pressure. The lack of dilation of the superior ophthalmic vein or other imaging features does not exclude the diagnosis and should not preclude angiography. The diagnosis is confirmed by angiography, which should be performed with consideration of the options for the ultimate treatment of the disease. Diagnostic arteriography is best performed by those who are charged with the ultimate treatment of the disease.