This study evaluated the effectiveness of intra-aneurysmal coil embolization for large or giant carotid artery aneurysms in the cavernous sinus in seven patients treated by intra-aneurysmal coil embolization from 2001 to 2010. Only one patient showed improved neurological symptoms caused by aneurysmal mass effect during the mean follow-up period of 53.4 ± 27.3 months. Neurological symptoms caused by the aneurysms remained unchanged in two patients, and deteriorated in four. Intra-aneurysmal coil embolization is not considered an effective treatment option for large or giant carotid artery aneurysms in the cavernous sinus.
The results indicate that endovascular coil embolization is a safe and effective treatment modality in selected patients with unruptured paraclinoid aneurysms. Consideration of the aneurysm size and the dome/neck ratio could assist in the selection of therapeutic modalities for these aneurysms.
A 52-year-old man presented with sudden severe headache. He was diagnosed with subarachnoid hemorrhage due to ruptured anterior wall aneurysm of the left internal carotid artery (ICA). Left frontotemporal craniotomy was performed followed by superficial temporal artery-middle cerebral artery (STA-MCA) double bypass, and the ICA was trapped just proximal to the posterior communicating artery with intracranial clipping, while simultaneously occluding the proximal ICA by endovascular coil embolization. The outcome of this patient demonstrates that hybrid operations with surgical clipping and endovascular coil embolization in a single stage can offer effective treatment.
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