American Journal of Neuroradiology, Vol 19, Issue 3 559-565, Copyright © 1998 by American Society of Neuroradiology
ARTICLES |
Endovascular therapy of idiopathic cavernous aneurysms over 11 years
G Bavinzski, M Killer, H Ferraz-Leite, A Gruber, CE Gross and B Richling
Department of Neurosurgery, University of Vienna Medical School, Austria.
PURPOSE: We report our experience with 42 patients with 48 cavernous carotid aneurysms, of whom 32 were treated with endovascular techniques and 10 were managed conservatively. METHODS: The 48 aneurysms were divided into two subgroups by location: 23 were at the C-3 portion of the carotid artery (small, saccular aneurysms with an epidural, partly intracavernous location) and 25 originated at the C4-5 segment (large or giant often fusiform aneurysms with a true intracavernous location). Morphologic features in both groups correlated well with differences in clinical presentation and also influenced therapy. Sixteen of the 25 C4- 5 aneurysms (all large or giant) were treated by balloon occlusion of the parent artery, four (with narrow necks) were treated with Guglielmi detachable coils (GDCs), and five were not treated (asymptomatic or minimally symptomatic). Twelve of 13 C-3 aneurysms were treated with GDCs. Ten C-3 aneurysms were not treated. RESULTS: Ophthalmoplegia resolved or improved in nine of 12 patients treated with parent artery occlusion. All aneurysms treated by carotid occlusion thrombosed. Twelve of the 17 aneurysms treated with GDCs were 100% filled by the coils, four were 80% to 95% filled, and one was only 40% filled. Seven of the 100% filled aneurysms remained completely occluded, two showed slight coil compaction, and in three, follow-up angiography was not available. Among the incompletely filled aneurysms, two remained unchanged, one showed progressive thrombosis, a fourth revealed coil compaction, and in one, follow-up angiography was not available. One thromboembolic stroke and three transient ischemic attacks occurred perioperatively, for a permanent morbidity of 3.5% and a transient morbidity of 9%. There was no mortality. Mean clinical follow-up was 33 months; mean angiographic follow-up of patients treated with GDCs was 11 months. CONCLUSION: Surgically difficult cavernous aneurysms can be obliterated by embolization with excellent clinical results. Detachable coils have become an important endovascular tool, especially for narrow- necked cavernous aneurysms of the C-3 segment, which can be protected against rupture in the subarachnoid space in most cases.
This article has been cited by other articles:
 |
|
 |
|
  W. Weber, R. Siekmann, B. Kis, and D. Kuehne Treatment and Follow-Up of 22 Unruptured Wide-Necked Intracranial Aneurysms of the Internal Carotid Artery with Onyx HD 500 AJNR Am. J. Neuroradiol., September 1, 2005; 26(8): 1909 - 1915. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Tomura, K. Omachi, S. Takahashi, I. Sakuma, T. Otani, J. Watarai, K. Ishikawa, H. Kinouchi, and K. Mizoi Comparison of Technetium Tc 99m Hexamethylpropyleneamine Oxime Single-Photon Emission Tomograph with Stump Pressure During the Balloon Occlusion Test of the Internal Carotid Artery AJNR Am. J. Neuroradiol., September 1, 2005; 26(8): 1937 - 1942. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N Goldenberg-Cohen, C Curry, N R Miller, R J Tamargo, and K P J Murphy Long term visual and neurological prognosis in patients with treated and untreated cavernous sinus aneurysms J. Neurol. Neurosurg. Psychiatry, June 1, 2004; 75(6): 863 - 867. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. C. van der Schaaf, E. H. Brilstra, E. Buskens, and G. J.E. Rinkel Endovascular Treatment of Aneurysms in the Cavernous Sinus: A Systematic Review on Balloon Occlusion of the Parent Vessel and Embolization With Coils Stroke, January 1, 2002; 33(1): 313 - 318. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Z. Dovey, M. Misra, J. Thornton, F. T. Charbel, G. M. Debrun, and J. I. Ausman Guglielmi Detachable Coiling for Intracranial Aneurysms: The Story So Far Arch Neurol, April 1, 2001; 58(4): 559 - 564. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. L. Weissman Old Problems, New Techniques: The Interventional Radiologist and the Lacrimal Apparatus Radiology, August 1, 1999; 212(2): 305 - 306. [Full Text]
|
|