Symptomatic Cavernous Sinus Aneurysms: Management and Outcome After Carotid Occlusion and Selective Cerebral Revascularization
Melvin Fielda,
Charles A. Jungreisb,
Nicole Chengelisa,
Holly Kromera,
Lori Kirbya and
Howard Yonasa
a Department of Neurological Surgery, University of Pittsburgh School of Medicine, PA
b Department of Radiology, University of Pittsburgh School of Medicine, PA
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FIG 1. Management algorithm for symptomatic cavernous sinus aneurysms. ICCA indicates intracavernous carotid artery aneurysm; EC-IC, extracranial-intracranial; STA-MCA, superficial temporal artery-to-middle cerebral artery
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FIG 2. Example of a xenon-enhanced CT CBF analysis for a patient at moderate risk for ischemic infarction after carotid occlusion. Quantitative BTO CBF analysis (BTO R ICA) identified decreased perfusion of the right ICA. The patient then underwent cerebral revascularization followed by carotid occlusion, with restored baseline CBF postoperatively. STA indicates superficial temporal artery. Each column represents a different brain level of CBF 5 min apart.
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FIG 3. Postocclusion infarction predicted by quantitative BTO in an 80-year-old woman who presented with left third, fourth, and sixth nerve palsies.
A, Digitally subtracted cerebral angiogram of the ICA (AP view) reveals a left cavernous ICA aneurysm. The patient underwent clinical BTO and did not develop neurologic symptoms.
B, Baseline and C, subsequent quantitative BTO by means of xenon-enhanced CT CBF analysis reveal decreased perfusion in the left ICA distribution, as well as worsening hemispheric asymmetry with temporary BTO. The patient then underwent a left superficial temporal artery-to-middle cerebral artery bypass followed by carotid occlusion.
D and E, Repeat images obtained at 6-month follow-up show a new left posterior middle cerebral artery branch infarction.
For B and C, top row shows correlative CT image level of CBF measurement and bottom row represents xenon-enhanced CT-CBF analysis.
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