Cavernous sinus aneurysms: risk of growth over time and risk factors

Abstract

OBJECTIVECavernous internal carotid artery (ICA) aneurysms are frequently diagnosed incidentally and the benign natural history of these lesions is well known, but there is limited information assessing the risk of growth in untreated patients. The authors sought to assess and analyze risk factors in patients with cavernous ICA aneurysms and compare them to those of patients with intracranial berry aneurysms in other locations.METHODSData from consecutive patients who were diagnosed with a cavernous ICA aneurysm were retrospectively reviewed. The authors evaluated patients for the incidence of cavernous ICA aneurysm growth and rupture. In addition, the authors analyzed risk factors for cavernous ICA aneurysm growth and compared them to risk factors in a population of patients diagnosed with intracranial berry aneurysms in locations other than the cavernous ICA during the same period.RESULTSIn 194 patients with 208 cavernous ICA aneurysms, the authors found a high risk of aneurysm growth (19.2% per patient-year) in patients with large/giant aneurysms. Size was significantly associated with higher risk of growth. Compared to patients with intracranial berry aneurysms in other locations, patients with cavernous ICA aneurysms were significantly more likely to be female and have a lower incidence of hypertension.CONCLUSIONSAneurysms of the cavernous ICA are benign lesions with a negligible risk of rupture but a definite risk of growth. Aneurysm size was found to be associated with aneurysm growth, which can be associated with new onset of symptoms. Serial follow-up imaging of a cavernous ICA aneurysm might be indicated to monitor for asymptomatic growth, especially in patients with larger lesions.

Symptomatic Cavernous Internal Carotid Artery Aneurysm Complicated by Simultaneous Rapid Growth of the Intra-aneurysmal and Parent Artery Thromboses

“…With recent technological advancements in neuroimaging, cavernous internal carotid artery (ICA) aneurysms are frequently diagnosed incidentally. 1) Most cavernous ICA aneurysms have benign natural histories, with low cumulative rates of rupture. 2) However, large (>15 mm) or giant (>25 mm) cavernous aneurysms may cause ophthalmoplegia, chemosis, ptosis, proptosis, visual changes, facial pain or numbness, and Horner’s syndrome (collectively called “cavernous sinus syndrome”) because of their mass effect.…”

“… 3 , 4) Moreover, recent literature reported that aneurysm size was a significant predictor of aneurysmal growth, and even asymptomatic large or giant aneurysms potentially present risks of new-onset symptoms. 1) Partial or complete thrombosis is not uncommon in such large/giant aneurysms, 5) and thromboembolic events caused by intra-aneurysmal thromboses have been also reported. 1) Although spontaneous intra-aneurysmal thrombosis involved parent artery thrombosis is rare and usually has good outcomes, some patients experience severe ischemic stroke.…”

“… 1) Partial or complete thrombosis is not uncommon in such large/giant aneurysms, 5) and thromboembolic events caused by intra-aneurysmal thromboses have been also reported. 1) Although spontaneous intra-aneurysmal thrombosis involved parent artery thrombosis is rare and usually has good outcomes, some patients experience severe ischemic stroke. 5) …”

Hemodynamic analysis and implantation strategies of delayed intracranial aneurysm rupture after flow diverter treatment

“…Sidewall ICA aneurysms have comparatively low annual rupture risk of 0.2%, but account for nearly 40% of all aneurysm cases (21). Compared with other sites, ICA aneurysms have higher growth risk and tend to cause compression of surrounding tissues due to the proximity to cranial nerve or brain structures that make it difficult to perform surgical access at this location (22). So in this study, we selected two cases of sidewall ICA aneurysms, one of which had postoperative bleeding and the other had no postoperative complications.…”

Nontraumatic Aneurysm—An Unusual Cause of Epistaxis

“…6 Nontraumatic CCAs are usually benign asymptomatic lesions, incidentally detected on imaging. 7 Symptoms caused by these aneurysms can be broadly divided into 2 types: compressive and vascular.…”