Complex paraclinoidal and giant cavernous aneurysms: importance of preoperative evaluation with temporary balloon occlusion test and SPECT (original) (raw)
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Presentation and treatment of carotid cavernous aneurysms
Arquivos De Neuro-psiquiatria, 2008
We analyzed a group of patients with the diagnosis of internal carotid aneurysms in its intracavernous segment, with emphasis in prevalence, clinical features, treatments, evolution and neurological prognosis. Neurological signs and symptoms at initial presentation were registered and compared with final outcome. Patients were divided into two stratified groups, one with 19 patients which underwent interventionist treatment, and another with 21 patients who were conservatively treated. The present study demonstrated that intervention is significantly correlated with a better prognosis considering evolution of pain symptoms secondary to neurovascular compression (p=0,002). Regarding neurological deficits, an interventionist approach was also significantly correlated with better outcome in comparison with initial presentation (p=0,008). These results indicate that interventionist treatment determines improvement or resolution of pain symptoms in comparison with patients conservatively treated, as well as stabilization or partial improvement of neuroophthalmological deficits.
Evolution of Management Strategies for Cavernous Carotid Aneurysms: A Review
World Neurosurgery, 2014
Objective: Cavernous carotid aneurysms are considered benign lesions with indolent natural history. Apart from idiopathic aneurysms, traumatic, iatrogenic and mycotic aneurysms are common in the cavernous segment of carotid artery. With rapid advances in endovascular therapy, management of cavernous carotid aneurysms has evolved over the years. Our aim was to review the management options available for management of cavernous carotid aneurysms.
Neuroradiology, 1992
We have studied the results of carotid occlusion in the treatment of giant intracavernous carotid artery (ICA) aneurysms in 40 patients. Clinical, angiographic, Doppler and cerebral blood flow (CBF) criteria for tolerance of occlusion are discussed. The patients had headaches (47.5 %), cranial nerve compression (87.5 % ), decreased visual acuity (20%), ruptured aneurysm (15 %) and 5 % were asymptomatic. Balloon occlusion tests were performed under light sedation anaesthesia: a successful test required perfect clinical tolerance and adequate angiographic collateral circulation in arterial, parenchymatous, and venous phases. Additional criteria included xenon 133 CBF measurements, and transcranial Doppler sonography of the middle cerebral artery. According to these criteria, 5 patients did not tolerate test occlusion and required an extra-intracranial (EC-IC) bypass. Mean follow-up was 4.7 years. All patients were radiologically cured of their aneurysm, and in 35 the symptoms resolved, although 3 had persistent ocular motor nerve palsies, and in 4 visual defects were unchanged. Complications were 1 permanent and 3 transient neurological deficits. Balloon occlusion of the ICA is an effective, reliable form of treatment for intracavernous giant aneurysm and should replace surgical ligation of the cervical carotid artery. With CBF or Doppler monitoring, the risk of neurological deficit is diminished. EC-IC bypass prior to ICA occlusion is indicated if test occlusion is not tolerated.
Cavernous Carotid Aneurysms: To Do or Not To Do?
Journal of Neurosciences in Rural Practice, 2017
ABSTRACTCavernous carotid aneurysms (CCA) pose considerable dilemmas in management. It is still unclear as to whether an asymptomatic CCA should be subjected to treatment. Similarly, the ideal management strategy for a symptomatic aneurysm is controversial. We present the case of a 60-year-old female with a giant CCA and discuss the management issues.
The benign course of cavernous carotid artery aneurysms
Journal of Neurosurgery, 1992
✓ Recently, the benign nature of aneurysms of the cavernous carotid artery has been questioned. In a review of cases evaluated from 1980 to 1990 with this developmental aneurysm, the authors found 70 patients with 79 cavernous carotid artery aneurysms. As expected, the great majority (59 patients) had ophthalmoplegia as the initial problem. Retro-orbital pain (three cases) and a carotid-cavernous fistula (five cases) were infrequently the sole manifestation. Mirror-image asymptomatic aneurysms were found in nine patients and asymptomatic cavernous aneurysms were found in three additional patients. Thirty-four patients not surgically treated were followed for a mean of 2.8 years, and 36 surgical patients were followed for a mean of 4.1 years prior to treatment. Of the 79 aneurysms, one (1.3%) ruptured into the subarachnoid space during this period. Other than optic neuropathy or cranial neuropathy, no patient had a permanent neurological deficit; the 12 asymptomatic aneurysms remaine...
Giant intracranial aneurysms are rare disorders that represent only 5 % of all intracranial aneurysms; they have a wide variety of presentations including rupture, embolic effects, and mass effect symptoms that can mislead the diagnosis to tumors rather than aneurysms. Their treatment is difficult and carries higher morbidity and mortality than usual aneurysms due to their complex nature. This study involved retrospective analysis of data of 28 patients, managed between 2006 and 2012, suffering from giant internal carotid artery (ICA) aneurysms with various presenting symptoms, none of which was hemorrhage. They were all evaluated by BOT prior to any intervention; they were subjected to various treatment strategies including selective coiling, parent artery occlusion with or without bypass, aneurysm trapping with or without bypass, and patients were followed for a period ranging from 6 months to 5 years. Out of 26 patients with giant aneurysms with mass effects, 16 patients showed full recovery (61.5 %), 5 showed partial improvement (19.2 %), and 5 showed no change in mass effect symptoms (19.2 %). One patient died (3.5 %). Symptoms such as TIA or epistaxis showed complete recovery. This study shows that a well-designed protocol aiming at parent artery sacrifice will yield good to excellent results in managing ICA giant aneurysms, and it also shows that parent artery sacrifice is superior to other forms of treatment of these lesions regarding recurrence rates, morbidity, and mortality.
Management of Extracranial Carotid Artery Aneurysms:17 Years» Experience
European Journal of Vascular and Endovascular Surgery, 1999
Objectives: a retrospective review of seventeen-year (1980-1996) experience of the management of extracranial carotid artery aneurysms. Patients and methods: sixty-six aneurysms of extracranial carotid artery were seen in 63 patients. The diagnosis was confirmed by angiography in 51 patients and duplex ultrasonography in twelve. Twenty-eight (42%) patients had an atherosclerotic aneurysm, twenty-two (33%) had false aneurysms secondary to trauma, nine were congenital and seven were mycotic. All underwent aneurysm resection with saphenous-vein-graft interposition as the most common means of reconstruction. Results: one death occurred due to septicaemia in a diabetic patient with a mycotic aneurysm, giving an operative mortality of 1.5%. One patient had an immediate hemiparesis after carotid artery ligation, and three had a hemiparesis within 48 hours of operation (6.1%). After a change in technique to avoid a residual carotid stump, no further neurological problems were encountered in the following 28 patients. Conclusion: extracranial carotid aneurysms may be successfully managed with resection and reconstruction with autogenous saphenous vein. End-to-side anastomosis avoids a blind-ending stump which may be the source of emboli.
Background and Objective: Giant cavernous carotid artery aneurysms (CCAAs) often produce a variety of neurological deficits, primarily those related to ophthalmoplegia/paresis and headache. This study was designed to evaluate the resolution of symptoms after parent artery occlusion (PAO) treatment for giant CCAAs. Methods: We retrospectively reviewed a series of 17 consecutive giant CCAAs treated with PAO treatment. All patients were evaluated by balloon occlusion test (BOT) before treatment. Patients who could tolerate BOT were treated by PAO. The following outcomes were analyzed: angiographic assessment, evolution of symptoms and outcome at clinical follow-up using modified Rankin Scale (mRS). Results: A total number of 17 giant CCAAs were treated by PAO. The initial post-procedure and follow-up angiogram revealed complete occlusion in all patients, no new lesion was detected. Periprocedural infarcts occurred in 1 patient (5.9%). Procedure-related mortality and morbidity were 0% and 5.9%, respectively. At mean 31.8 months clinical follow-up, symptoms had disappeared in 7 (41.2%) of the patients, partially improved in 5 (29.4%), remained unchanged in 4 (23.5%) and worsened in 1 (5.9%) of cases. Sixteen (94.1%) patients presented a good clinical outcome (mRS 0 - 1). Conclusion: Most patients in our series improved or remained stable after PAO. The results of this study indicate that PAO can improve the outcome of those symptomatic giant CCAAs if BOT can be tolerated.
Cavernous Carotid Artery Giant Aneurysm: Case Report and Literature Review
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
The giant aneurysm of the cavernous internal carotid artery is an uncommon event. In the case of giant aneurysmal formation, the patient presents with some signs or symptoms, reported or observed on physical examination, which reveal a possible mass effect with neurovascular compression of the aneurysm, or even a subarachnoid hemorrhage due to the rupture of the aneurysm. We report the case of a 69-year-old patient who was admitted to the emergency department, referred by the basic health unit (BHU) of her locality for neurosurgical evaluation after suffering a mild traumatic brain injury (TBI). The patient, who was asymptomatic, carried with her a tomographic computerized examination of the skull, performed one day after the incident, evidencing left nodular parasellar lesion involving the cavernous sinus, discovered at random. After more specific clinical, laboratory and imaging exams, she was diagnosed with a giant aneurysm of the cavernous segment of the left internal carotid ar...
Multimodality Treatment of Complex Unruptured Cavernous and Paraclinoid Aneurysms
Neurosurgery, 2014
BACKGROUND: Unruptured aneurysms of the cavernous and paraclinoid internal carotid artery can be approached via microsurgical and endovascular approaches. Trends in treatment reflect a steady shift toward endovascular techniques. OBJECTIVE: To analyze our results with multimodal treatment. METHODS: We reviewed patients with unruptured cavernous and paraclinoid internal carotid artery aneurysms proximal to the posterior communicating artery treated at a single center from 2007 to 2012. Treatment included 4 groups: (1) stent-assisted coiling, (2) pipeline endovascular device (PED) flow diverter, (3) clipping, and (4) trapping/bypass. Follow-up was 2 to 60 months. RESULTS: The 109 aneurysms in 102 patients were studied with the following treatment groupings: 41 were done with stent-assisted coiling, 24 with Pipeline endovascular device, 24 by microsurgical clipping, and 20 by trap/bypass. Group: (1) two percent had delayed significant intraparenchymal hemorrhage; (2) thirteen percent h...