Presentation and treatment of carotid cavernous aneurysms

Abstract

-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.Key WoRds: carotid cavernous aneurysm, clinical treatment, interventionist treatment, prognosis. apresentação e tratamento dos aneurismas intracavernososResumo -Analisamos um grupo de pacientes com diagnóstico de aneurismas da artéria carótida interna, em sua porção intracavernosa, estudando-se: prevalência, apresentação clínica, formas de tratamento, evolução e prognóstico neurológico. os sintomas e sinais neurológicos da apresentação foram registrados e comparados ao término do acompanhamento, com um grupo de 21 aneurismas submetidos a tratamento conservador e outro com 19 a tratamento intervencionista. o estudo demonstrou que a intervenção está relacionada a um melhor prognóstico, quanto à evolução do quadro álgico secundário à compressão neurovascular (p=0,002). em relação ao déficit neurológico, a abordagem intervencionista pôde ser associada com uma melhora do quadro inicial (p=0,008). estes resultados indicam que o tratamento intervencionista proporcionou melhora ou resolução do sintoma dor em comparação ao grupo de pacientes com tratamento conservador, além de levar a uma estabilização ou melhora parcial dos déficits neuro-oftalmológicos.

Cavernous carotid aneurysms: to treat or not to treat?

“…20,28,38,40,48 Epidemiology and Natural History Cavernous carotid aneurysms account for 2-9% of all intracranial aneurysms. 55,62 The etiology of CCAs can be traumatic, infectious, or idiopathic. The most common sites for traumatic cerebral aneurysms, which constitute only 0.04-0.15% of all intracranial aneurysms, are the cavernous and petrous segments of the ICA (~ 40%), and the lesions are most often associated with basal skull fractures.…”

“…The most common sites for traumatic cerebral aneurysms, which constitute only 0.04-0.15% of all intracranial aneurysms, are the cavernous and petrous segments of the ICA (~ 40%), and the lesions are most often associated with basal skull fractures. 55,62 Infectious aneurysms involving the cavernous segment of the ICA are extremely rare and are thought to primarily arise from septic embolization of bacterial endocarditis. 26 The etiology of idiopathic CCAs is thought to be the same as for other intracranial aneurysms, with common risk factors being hypertension, smoking, family history, and connective tissue disorders.…”

“…The risk of CCA rupture is thought to be dependent on multiple factors, most commonly aneurysm size. 55,62 Rupture risk of CCAs has not been characterized with respect to the various ways that CCAs can rupture and therefore has traditionally been reported as a whole. The rupture risk of infectious CCAs is unknown due to their rarity.…”

“…11,33,55,62,66 However, several conditions exist in which treatment of these aneurysms must be considered, namely, large lesions, which confer increased risk of rupture according to the ISUIA data; 66 symptomatic lesions that undergo acute thrombotic changes; lesions that have evidence of aneurysm growth; unruptured symptomatic lesions with mass effect; unruptured lesions causing significant local bone erosion; and/or ruptured lesions. The current modalities of CCA treatment include expectant management, luminal preservation strategies, and Hunterian strategies with or without revascularization procedures.…”

Spontaneous thrombosis of internal carotid artery: a natural history of giant carotid cavernous aneurysms

“…However, it can be catastrophic for those patients without efficient collateral circulation. Complete cerebral angiographic study, associated with internal carotid occlusion test with balloon is important, since it can indicate by-pass surgery for these patients, avoiding potentially dangerous outcome 29 . …”