Aneurysms of the Intracavernous Carotid Artery: Natural History and Indications for Treatment

Abstract

Of 37 patients with 44 intracavernous carotid artery aneurysms (ICCAAns) diagnosed between 1976 and 1988. patients with 20 aneurysms were followed without treatment for 5 months to 13 years (median, 2.4 years). Ten of the 20 ICCAAns were asymptomatic at diagnosis, and 10 were symptomatic. Three of the asymptomatic ICCAAns were symptomatic at follow-up. One of these required clipping because of a progressing cavernous sinus syndrome; the other 2 were minimally symptomatic and have not required treatment. Of the 10 initially symptomatic ICCAAns, 2 had not changed, 4 became more symptomatic, and 4 had symptomatically improved by follow-up. One patient with an ICCAAn that had not changed clinically was lost to follow-up 6 months after diagnosis. Of the 4 ICCAAns that became more symptomatic, 2 continue to be monitored, and 2 required intervention; one with detachable balloon occlusion of the aneurysm with preservation of the internal carotid artery lumen, and the other with gradual cervical internal carotid artery occlusion. The clinical course of this selected group of patients with ICCAAns suggests that the natural history of ICCAAns can be quite variable. Although clinical progression does occur, symptomatic ICCAAns also can improve spontaneously. Therapeutic intervention for asymptomatic ICCAAns should be reserved for patients with aneurysms arising at the anterior genu of the carotid siphon and/or extending into the subarachnoid space, where subarachnoid hemorrhage is most likely. Intervention for symptomatic ICCAAns should be reserved for patients with subarachnoid hemorrhage, epistaxis, severe facial or orbital pain, evidence of radiographic enlargement, progressive ophthalmoplegia, or progressive visual loss.

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

“…Considering our patients been submitted to conservative treatment, it could be verified a relapsing and fluctuating course of pain symptoms and a progressive impairment of cranial nerves' function, determining a poor neurological outcome till the spontaneous occlusion of ICA 27 , when the pain scenario, determined by headache, hemifacial pain and retrobulbar pain, was improved or extinguished in all cases.…”

“…Most clinical investigators have found an increasing risk of thrombosis with an increasing degree of stenosis [14][15][16][17][18][19] and preceded by rupture of atherosclerotic plaques 20,21 , but observations concerning plaque ulcerations [12][13][14][15][16] and intraplaque hemorrhages 22,23 have been more uncertain and controversial. The occlusion of ICA can be a dangerous complication to patients without a patent collateral circulation [24][25][26][27] , manifested as an ischemic scenario, with a devastating cerebrovascular accident, or results in spontaneous therapeutic with a patent collateral circulation.…”

“…As to measure, according to Linskey et al 27 , pain symptoms and neurological deficits, the pain was graduated in severe, moderate, weak or absent, while neurological deficits were classified as severe, in the presence of cavernous sinus syndrome including trigeminal neuropathies; moderated, if there were complete involvement of III, IV and VI cranial nerves; weak, if there were deficits in one or two cranial nerves; and absent.…”

Aneurisma gigante do segmento intracavernoso da carótida interna associado a doença renal policística autossômica dominante: relato de caso

“…Grande número dessas lesões permanece assintomática, e HSA se torna uma preocupação somente quando o aneurisma ultrapassa o anel dural distal da carótida, projetandose para o espaço subaracnóideo intradural 3,5,11 . Em 2 estudos, totalizando 90 pacientes, o risco de HSA foi de apenas 0,4% por paciente-ano 4,12 . Mais freqüen-temente, a ruptura desses aneurismas leva a uma fís-tula carótido-cavernosa direta 11,13 .…”

“…São tratados os aneurismas intracavernosos que se apresentam com ruptura aguda, compressão de nervos cranianos, episódios tromboembóli-cos ou, nos pacientes assintomáticos, quando o aneurisma se estende ao espaço subaracnóideo extracavernoso, elevando o risco de sangramento [2][3][4][5][11][12][13]24 .…”