Matricidal cavernous aneurysms: a multicenter case series

Abstract

BackgroundCavernous carotid artery aneurysms (CCAs) represent a unique subset of intracranial aneurysms due to their distinct natural history and the anatomy of the cavernous sinus. Enlarging CCAs can cause elastic compression of the parent internal carotid artery (ICA). We suggest defining aneurysms that cause luminal stenosis of their parent vessels as ‘matricidal aneurysms.’Though many patients are asymptomatic, presenting symptoms of CCAs include ophthalmoplegia with resulting diplopia, vision changes, pain, ptosis, facial numbness, and cavernous-carotid fistula. Less commonly, patients with CCAs can present with epistaxis, subarachnoid hemorrhage, and—in cases of matricidal aneurysms—ischemia due to stenosis. The proper management of stenosis caused by a matricidal CCA is not well established and may not be intuitive.MethodsWe present a multicenter retrospective case series of patients with matricidal CCAs.ResultsForty patients with matricidal aneurysms presented with both asymptomatic and symptomatic stenosis. These patients were either treated with conservative medical management, coiling, flow diversion, or endovascular sacrifice of the parent artery. Planned treatment modalities were not executed in 11 cases (28% treatment failure rate). Presenting symptoms, patient outcomes, and follow-up data are presented for all cases.ConclusionMatricidal aneurysms require careful consideration and planning. The restricted anatomy of the cavernous sinus can make successful execution of endovascular interventions more difficult. Direct elastic compression of the parent artery does not respond to angioplasty and stenting in the same way atherosclerotic stenosis does. Because of this, planning for the possibility of parent vessel sacrifice is important.

Challenging access during flow diversion treatment of a giant cavernous ICA aneurysm

“… 1 The giant aneurysm encompasses the cavernous segment of the ICA and even compresses the arterial inflow; thus, we call this a matricidal aneurysm. 2 …”

Spontaneous Thrombosis of a Giant Cavernous Internal Carotid Artery Aneurysm and Parent Vessel Occlusion in a Patient With Bilateral Cavernous Internal Carotid Artery Aneurysms

“…Because of the anatomic location of the cavernous ICA within the cavernous sinus, these aneurysms can cause cavernous sinus syndrome. Cavernous sinus syndrome often manifests as ophthalmoplegia, visual changes, ptosis, proptosis, facial pain or numbness, and Horner's syndrome [2,3]. Spontaneous thrombosis of large aneurysms is a well-known phenomenon, with the frequency reported to be 13%-60% [4][5][6][7][8].…”

Transcirculation Approach for Matricidal Carotid Cavernous Aneurysm: Not a Good Choice – A Case Report of Unsuccessful Endovascular Treatment of Matricidal Carotid Cavernous Aneurysm

“…Carotid cavernous aneurysms (CCAs) account for 2–13% of all intracranial aneurysms [ 1 , 2 ]. They differ, however, from aneurysms from the subarachnoid location by clinical presentation and natural history.…”

“…Some CCAs grow to such large sizes (called matricidal aneurysms) that they may compromise the parent internal carotid artery (ICA). The treatment failure of matricidal CCAs is high, in some cases reaching up to 28% [ 1 ]. Those patients require an individual therapeutic approach and a collaborative team.…”