A Retrospective Analysis of Treatment Outcomes of 40 Incidental Cavernous Carotid Aneurysms

Kumar, Amit; Kutty, Raja K; Yamada, Yashuhiro; Tanaka, Riki; Ravisankar, Vigeshwar; Musara, Aaron; Miyatani, Kyosuke; Higashiguchi, Saeko; Kawase, Tsukasa; Takizawa, Kazuyasu; Kato, Yōkō

doi:10.1016/j.wneu.2019.07.071

Cited by 10 publications

(12 citation statements)

References 25 publications

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“…Precedent clinical CCA series seldom describe patients with asymptomatic CCA; however, with the increasing availability of CT and MRI, many CCA are discovered incidentally [3,24]. In a recent series, up to 40% of patients are asymptomatic, and the CCA is incidentally found, which matches the observations in our cohort [18,25].…”

Section: Discussionsupporting

confidence: 86%

“…In addition to several case reports and case series, two larger cohorts of patients with CCA have been published. In line with Stiebel-Kalish et al (185 patients), Kumar et al published their experience with 39 patients [8,18]. There are also reports on treatment options and the outcome of patients with giant cavernous carotid aneurysms [19,20].…”

Section: Introductionmentioning

confidence: 80%

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Management of Cavernous Carotid Artery Aneurysms: A Retrospective Single-Center Experience

et al. 2022

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Objective: While cavernous carotid aneurysms can cause neurological symptoms, their often-uneventful natural course and the increasing options of intravascular aneurysm closure call for educated decision-making. However, evidence-based guidelines are missing. Here, we report 64 patients with cavernous carotid aneurysms, their respective therapeutic strategies, and follow-up. Methods: We included all patients with cavernous carotid aneurysms who presented to our clinic between 2014 and 2020 and recorded comorbidities (elevated blood pressure, diabetes mellitus, and nicotine consumption), PHASES score, aneurysm site, size and shape, therapeutic strategy, neurological deficits, and clinical follow-up. Results: The mean age of the 64 patients (86% female) was 53 years, the mean follow-up time was 3.8 years. A total of 22 patients suffered from cranial nerve deficit. Of these patients, 50% showed a relief of symptoms regardless of the therapy regime. We found no significant correlations between aneurysm size or PHASES score and the occurrence of neurological symptoms. Conclusion: If aneurysm specific symptoms persist over a longer period of time, relief is difficult to achieve despite aneurysm treatment. Patients should be advised by experts in neurovascular centers, weighing the possibility of an uneventful course against the risks of treatment. In this regard, more detailed prospective data is needed to improve individual patient counseling.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 80%

Management of Cavernous Carotid Artery Aneurysms: A Retrospective Single-Center Experience

et al. 2022

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“…Among 111 untreated patients, 2% had stroke, 1% had SAH, 1% had direct CCF, and 6% developed compressive optic neuropathy leading to overall 10% adverse events rate. [ 8 9 ]…”

Section: Discussionmentioning

confidence: 99%

“…Among 111 untreated patients, 2% had stroke, 1% had SAH, 1% had direct CCF, and 6% developed compressive optic neuropathy leading to overall 10% adverse events rate. [8,9] CCAs can be managed by open surgical methods such as clipping, trapping with or without bypass or endovascular methods. Endovascular coiling with or without stent carry a high rate of recanalization and re-treatment.…”

Section: Discussionmentioning

confidence: 99%

High-flow bypass with radial artery graft for cavernous carotid aneurysm

et al. 2020

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“…[7] The incidence of CCAs is higher in females than males. [8] The possible etiologies include traumatic (the most common), infectious, or idiopathic. [5,8] The risk factors for idiopathic CCAs include hypertension, cigarette smoking, genetics, and connective tissue diseases.…”

Section: Introductionmentioning

confidence: 99%

High-flow bypass with radial artery graft for cavernous carotid aneurysms: A case series

et al. 2020

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Background: The incidence of cavernous carotid aneurysms (CCAs) of intracranial aneurysms is low. Majority of cases presented as incidental findings with benign natural progression. The most common presenting symptoms are multiple cranial neuropathies among symptomatic patients. The treatment modalities for symptomatic patients include direct surgical clipping, endovascular coil embolization, or placement of flow diverter, or indirect procedures such as occlusion of parent artery with and without revascularization techniques. The advancement in the microsurgical treatments and endovascular devices have enable a high success rate in the treatment of patients with CCAs with low morbidity and mortality rates. Objective: To study the surgical outcomes of patients with cavernous aneurysm who underwent high-flow bypass between 2015 and 2020 in our institution. Materials and Methods: A total of six patients in a single institution presented with CCAs who were treated with high-flow bypass surgery were included in this case-series. A single-case illustration was presented focusing on the details of surgical case management of CCA. The intraoperative middle cerebral artery (MCA) pressure monitoring during bypass surgery was also described. Results: All five female patients and one male patient who were diagnosed with cavernous carotid aneurysms were studied. The mean age was 68.8 years old (range: 24-84 years old) and the mean size of the aneurysm was 19.6mm (range: 9.7 – 30mm). There were successfully treated with high flow bypasses using radial artery graft without any neurological sequelae. Conclusion: The surgical treatments of cavernous carotid aneurysms should be limited to experienced neurosurgeons in view of significant risk of morbidity and mortality. Endovascular procedures may be the main stay of treatments. The success shown in this case series with parent artery occlusion and bypass surgery may provide an safe alternative to the endovascular treatment.

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A Retrospective Analysis of Treatment Outcomes of 40 Incidental Cavernous Carotid Aneurysms

Cited by 10 publications

References 25 publications

Management of Cavernous Carotid Artery Aneurysms: A Retrospective Single-Center Experience

Management of Cavernous Carotid Artery Aneurysms: A Retrospective Single-Center Experience

High-flow bypass with radial artery graft for cavernous carotid aneurysm

High-flow bypass with radial artery graft for cavernous carotid aneurysms: A case series

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