Cavernous Sinus Fistula

A cavernous sinus fistula happens when the internal and external carotid arteries and the cavernous sinus gets their "communication" mixed up.  These patients usually see an eye doctor first with eye pain or proptosis.  Sometimes these happen spontaneously but more often by trauma.  A usual protocol for our facility would be images of the entire brain,but also including:
Pre-contrast of orbits

• T1 fatsat coronal      
•  T1 Axial 
•  thin slice Cor T2 

Post contrast of orbits:

• Fat sat Axial T1
• Fat sat Cor T1
• Fat sat Sagital Oblique (angled with optic nerve) of both orbits

The following web site has some basic information:  http://emedicine.medscape.com/article/1217766-overview

The following images are from a patient with a cavernous sinus fistula right side seen posterior orbit cavity.  You can also see the proptosis in the right eye compared to the left.

T2 Axial

T2 coronal

T1 axial

T1 axial post contrast fatsat

T1 Sagital oblique post contrast fatsat