A rare but morbid neurosurgical target: petrous aneurysms and their endovascular management in the stent/flow diverter era

Abstract

Endovascular treatment of large or symptomatic petrous ICA aneurysms, in the era of flow diversion, is associated with excellent angiographic and clinical outcomes.

Petrous Internal Carotid Artery Aneurysm: A Systematic Review

“…There are only 25 cases that are reported the outcomes of cranial nerve after the treatment 12,13,19,24,25,30,41,44,46,48,54,55,59,61,72,88 . Regarding the analyses of different treatments, there are only a few reports 9,13,14,19,83 on PA patients treated with a flow diverter stent. We think that the number of studies reporting the use of a flow diverter will increase in the future, and this difference may aid in elucidate the treatment effects of flow diverter and parent artery occlusion or entrapment.…”

“…To direct treatment strategies for cranial nerve palsy due to PAs in the future, we conducted a literature review of previously reported cases 6,7,[9][10][11][12][13][14][15][16]19,20,[24][25] . We searched for all reported case studies and clinical research papers regarding PAs that were published in English.…”

“…Additionally, as this portion was circumscribed by the cranial bone, coil embolization may have worsened the compression of the aneurysm and the nerve palsy 21,22 . A flowdiverter stent is a good option, and it has been increasingly reported 13,14,19 as effective for an extracranial IC aneurysm. However, we think the placement of the stent in this portion is technically difficult, and it is associated with a high risk because the petrous segment is located near the curved portion of the IC.…”

“…Petrous internal carotid aneurysm (PA) is a relatively rare disease 8 , with a wide variety of etiologies, including infection 9 , trauma 10,11 , and pseudoaneurysms 12 and has been taken up in 2004 8 . In recent years, an increasing number of treatments for PA, such as use of a flow diverter 9,13,14 , have been reported; however, revascularization surgery remains an important strategy 10,15 . Many PA patients are difficult to treat intravascularly, particularly those with infectious diseases 6,16 , ruptures 17 , and pseudoaneurysm 16 .…”

“…With respect to the symptoms of unruptured PAs, cranial nerve symptoms are commonly reported 8,12,13,19,20 . Several studies have investigated the effects of treatment for cranial nerve symptoms of the internal carotid artery-posterior communicating artery (ICPC) aneurysms 19,21,22 or cavernous carotid aneurysms 23 ; however, there are few reports 8,19,24,25 focusing on the effects of treatment for cranial nerve symptoms of PAs.…”