1
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Jha R, Zhao M, Ghannam JY, Blitz S, Chalif JI, Altshuler M, Du R. Benign Natural Progression of Small Cavernous Carotid Aneurysms Suggests Limited Clinical Utility of Serial Longitudinal Follow-up. Neurosurgery 2024:00006123-990000000-01218. [PMID: 38899866 DOI: 10.1227/neu.0000000000003033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/15/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Aneurysms in the cavernous segment of the internal carotid artery (ICA) often present in an indolent fashion with limited morbidity. However, their growth progression and possible rupture over time remains poorly defined, thereby limiting optimization of serial follow-up. Thus, we aim to describe the progression of cavernous ICA aneurysms over time, as well as the patient and aneurysm characteristics associated with possible growth and rupture status. METHODS We identified a consecutive cohort of 157 patients from 2007 to 2021 with cavernous ICA aneurysms. Patient demographic data, possible risk factors, presenting symptoms, radiographic features of aneurysms, size progression, rupture status, and concomitant noncavernous aneurysm rupture data were manually extracted. RESULTS One hundred and fifty-seven patients (mean age at diagnosis 57.2 ± 15.6 years; 85.4% females) with 174 cavernous carotid aneurysms (CCAs) were followed for an average of 7.1 ± 4.8 years. 76.4% of aneurysms were identified incidentally, with predominantly ocular palsies as the presenting symptoms in remaining primary cases. Most aneurysms were small, and of the 168 aneurysms that were followed, 98.2% did not demonstrate appreciable growth. Of the aneurysms that grew, it took an average of 6.0 years to grow 1.6 ± 0.2 mm. Demographic data, hypertension, and smoking status were not associated with aneurysm growth. Most radiographic features also were not associated with growth, except long-axis diameter, which had an odds ratio of 1.4 (CI: 1.2, 1.8) on multivariable analysis. Presenting clinical symptoms were not associated with growth. No CCAs ruptured during follow-up. CONCLUSION Cavernous ICA aneurysms in our series demonstrate no rupture and limited growth over years of clinical follow-up. No radiographic or patient risk factors were associated with growth except initial aneurysm size. Hence, small CCAs may not require close follow-up over time.
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Affiliation(s)
- Rohan Jha
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Maryann Zhao
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jack Y Ghannam
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sarah Blitz
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Joshua I Chalif
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Marcelle Altshuler
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rose Du
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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2
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Wang MX, Nie QB. Giant cavernous aneurysms occluded by aneurysmal thrombosis, calcification, parent artery occlusion: A case report and review of literature. World J Clin Cases 2024; 12:2822-2830. [PMID: 38899288 PMCID: PMC11185339 DOI: 10.12998/wjcc.v12.i16.2822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/26/2024] [Accepted: 03/13/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Patients with giant intracranial aneurysms (GIAs) are at a high risk of rupture, morbidity, and mortality even after surgical or endovascular treatment. We described a case of a spontaneously occluded GIA secondary to gradual growth of the GIA, continuously progressed aneurysmal thrombosis, complete aneurysmal calcification and complete occlusion of the parent artery-the right internal carotid artery (RICA). CASE SUMMARY A 72-year-old female patient complained of sudden pain in her right eye upon admission to our hospital. She had been diagnosed with a GIA [30 mm (axial) × 38 mm (coronal) × 28 mm (sagittal)] containing an aneurysmal thrombus located in the cavernous sinus segment of RICA diagnosed by magnetic resonance imaging (MRI), enhanced MRI, and magnetic resonance angiography more than 14 years ago. Later, with slow growth of the cavernous carotid GIA, aneurysmal thrombosis progressed continuously, spontaneous occlusion of the RICA, complete aneurysmal calcification, and occlusion of the GIA occurred gradually. She had no history of subarachnoid hemorrhage but missed the chance for endovascular therapy at an early stage. As a result, she was left with severe permanent sequelae from the injuries to the right cranial nerves II, III, IV, V1/V2, and VI. CONCLUSION The risk of rupture of the cavernous carotid GIAs was relatively low and possibly further be reduced by the stasis flow and spontaneous occlusion of the parent artery internal carotid artery (ICA) induced by the mass effect of the cavernous carotid GIAs and the extremely rare aneurysmal calcification. However, nowadays, it is advisable to recommend early endovascular treatment for the cavernous carotid GIAs to prevent injuries to the surrounding intracranial nerves and occlusion of the ICA, mainly caused by the mass effect of the cavernous carotid GIAs.
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Affiliation(s)
- Ming-Xi Wang
- School of Medicine, Huaqiao University, Xiamen 361021, Fujian Province, China
| | - Qing-Bin Nie
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing 100853, China
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3
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Rosi Junior J, Gomes Dos Santos A, Solla DJF, Rabelo NN, da Silva SA, Iglesio RF, Caldas JGMP, Teixeira MJ, Figueiredo EG. Cavernous carotid aneurysms do not influence the occurrence of upstream ipsilateral aneurysm. Br J Neurosurg 2024; 38:205-207. [PMID: 33170054 DOI: 10.1080/02688697.2020.1820950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 08/29/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Cavernous carotid aneurysms (CCA) comprehend around 5% of all intracranial aneurysms. The main risk factors for an intracranial aneurysm seem not to influence the incidence of CCAs. The aim of this study was to investigate the association of CCAs and the presence of upstream aneurysms. METHODS 1403 patients, admitted in Hospital das Clinicas de São Paulo, Brazil, from September 2009 to August 2018, enrolled this study. Diagnosis was performed with Digital Subtraction Angiography (DSA). Upstream aneurysm was defined as an intracranial aneurysm on anterior cerebral circulation, ipsilateral to the CCA (if present) or crossing the midline (e.g. anterior communicating artery). RESULTS 177 individuals were diagnosed with CCA (12.6% of the population), totalizing 225 aneurysms (10% of the total number of aneurysms, 2253). No association was found between CCA and UA (p= .090, OR: 1.323, 95% CI: 0.957-1.828). Studying only patients with CCA, multivariable analysis showed smoking as the only factor associated with UA (p= .010, OR: 0.436, 95% CI: 0.232-0.821). CONCLUSIONS Cavernous carotid aneurysms were present in 12% of our population, mostly in female. They seem to be independent of the modifiable risk factors already associated with intracranial aneurysms. A higher frequency of mirror aneurysms was seen in this location. CCA did not influence the presence of ipsilateral and anterior circulation aneurysms.
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Affiliation(s)
- Jefferson Rosi Junior
- Division of Neurological Surgery, Hospital das Clinicas, University of São Paulo Medical School, Sao Paulo, Brazil
| | | | - Davi Jorge Fontoura Solla
- Division of Neurological Surgery, Hospital das Clinicas, University of São Paulo Medical School, Sao Paulo, Brazil
| | | | - Saul Almeida da Silva
- Division of Neurological Surgery, Hospital das Clinicas, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Ricardo Ferrareto Iglesio
- Division of Neurological Surgery, Hospital das Clinicas, University of São Paulo Medical School, Sao Paulo, Brazil
| | | | - Manoel Jacobsen Teixeira
- Division of Neurological Surgery, Hospital das Clinicas, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Eberval Gadelha Figueiredo
- Division of Neurological Surgery, Hospital das Clinicas, University of São Paulo Medical School, Sao Paulo, Brazil
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4
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Ito Y, Maruichi K, Nakayama N, Kobayashi H, Tatezawa R, Shinada S, Terasaka S. Alternative Bypass Technique Using Radial Artery Graft between V3 Segment of Vertebral Artery and Middle Cerebral Artery: Technical Note. J Neurol Surg A Cent Eur Neurosurg 2023. [PMID: 37832591 DOI: 10.1055/s-0043-1775989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
BACKGROUND There are some cases where a radial artery (RA) graft is needed for a high-flow extracranial to intracranial (EC-IC) bypass as the external carotid artery (ECA) cannot be utilized as a donor artery. In this report, we describe two cases of extracranial vertebral artery (VA) to middle cerebral artery (MCA) high-flow bypass using an RA graft with an artificial vessel as an alternative bypass technique. METHODS The patient was placed supine with a head rotation of 80 degrees. After frontotemporal craniotomy, another C: -shaped skin incision was made at the retroauricular region and the V3 portion of the VA was exposed at the suboccipital triangle. Prior to attempting the high-flow bypass, the superficial temporal artery (STA) was anastomosed to the M4 portion of the MCA as an insurance bypass. The RA graft was anastomosed to the V3 portion of the VA that traveled under the periosteum at the supra-auricular region through an artificial vessel. After RA-M2 anastomosis, an alternative EC-IC bypass, the V3-RA-M2 bypass, was achieved. RESULTS Postoperative angiography demonstrated successful graft patency and no perioperative complications were observed in both cases. CONCLUSIONS In the cases where a high-flow bypass is required, the V3 portion of the VA is a suitable alternative proximal anastomosis site when the ECA is not a candidate donor. Furthermore, an artificial vessel shows satisfactory protection against graft complications.
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Affiliation(s)
- Yasuhiro Ito
- Department of Neurosurgery, Kashiwaba Neurosurgical Hospital, Hokkaido, Japan
| | - Katsuhiko Maruichi
- Department of Neurosurgery, Kashiwaba Neurosurgical Hospital, Hokkaido, Japan
| | - Naoki Nakayama
- Department of Neurosurgery, Kashiwaba Neurosurgical Hospital, Hokkaido, Japan
| | - Hiroyuki Kobayashi
- Department of Neurosurgery, Kashiwaba Neurosurgical Hospital, Hokkaido, Japan
| | - Ryota Tatezawa
- Department of Neurosurgery, Kashiwaba Neurosurgical Hospital, Hokkaido, Japan
| | - Shinitirou Shinada
- Department of Neurosurgery, Kashiwaba Neurosurgical Hospital, Hokkaido, Japan
| | - Shunsuke Terasaka
- Department of Neurosurgery, Kashiwaba Neurosurgical Hospital, Hokkaido, Japan
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5
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Lorga T, Pizzuto S, Coskun O, Sgreccia A, Cavazza M, Rahman MH, Rodesch G, Di Maria F, Consoli A. Reconstruction of the sphenoid sinus erosion or dehiscence after treatment of unruptured intracavernous aneurysms with flow diverter stents. J Neurointerv Surg 2023:jnis-2023-020734. [PMID: 37586819 DOI: 10.1136/jnis-2023-020734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/03/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Intracavernous carotid aneurysms (ICCAs) are rare, frequently asymptomatic, with a low rupture risk, which, however, can lead to life-threatening epistaxis. The aim of this study was to assess the effect of the treatment of asymptomatic ICCAs with flow diverters (FD) on sphenoid bone erosion or dehiscence in a selected cohort of patients. METHODS We retrospectively reviewed all asymptomatic ICCAs with sphenoid bone erosion or dehiscence detected on cone beam CT (CBCT) and treated with FD between December 2018 and December 2022. Patients were followed-up with CBCT and bone reconstruction was blindly evaluated by two interventional neuroradiologists and classified as unchanged, partial, or complete. RESULTS A total of 10 patients (women: 90%, mean age 58 years) treated with an FD for an asymptomatic ICCA with associated sphenoid bone erosion or dehiscence were included in this cohort. Sphenoid bone erosion was present in seven patients and dehiscence was observed in the remaining three. After treatment with FD, complete reconstruction of the sphenoid sinus wall occurred in seven cases, and partial reconstruction in two cases. Sphenoid bone erosion remained unchanged after treatment in only one patient. CONCLUSIONS The decision to treat asymptomatic and unruptured ICCAs remains challenging due to their benign natural history and low hemorrhagic risk. The presence of sphenoid sinus erosion or dehiscence should not be overlooked since it could be considered as an indication for prophylactic treatment of life-threatening epistaxis. The mechanisms of bone erosion by the aneurysm and of reconstruction after treatment are still to be fully elucidated.
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Affiliation(s)
- Tiago Lorga
- Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, France
- Neuroradiology, Centro Hospitalar Universitário de Lisboa Central EPE, Lisboa, Portugal
| | - Silvia Pizzuto
- Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, France
| | - Oguzhan Coskun
- Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, France
| | - Alessandro Sgreccia
- Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, France
| | - Martino Cavazza
- Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, France
- Diagnostic and Interventional Radiology, University Hospital Arcispedale Sant'Anna of Ferrara, Cona, Italy
| | - Mohammad Habibur Rahman
- Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, France
- Interventional Neurology, National Institute of Neurosciences and Hospital, Sher-E-Bangla Nagar, Bangladesh
| | - Georges Rodesch
- Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, France
| | - Federico Di Maria
- Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, France
| | - Arturo Consoli
- Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, France
- Versailles Saint-Quentin-en-Yvelines University, Versailles, France
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Mueller I, Spoerri M, Job O, Fierz F, Weber K. Minor Traumas with Major Consequences: Penetrating Transorbital Injuries with Sharp Objects. Klin Monbl Augenheilkd 2023; 240:461-463. [PMID: 37164423 DOI: 10.1055/a-2011-6205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Isabelle Mueller
- Ophthalmology, University Hospital of Zurich, Zurich, Switzerland
| | | | - Oliver Job
- Cantonal hospital of Lucerne, Lucerne, Switzerland
| | - Fabienne Fierz
- Ophthalmology, University Hospital of Zurich, Zurich, Switzerland
| | - Konrad Weber
- Ophthalmology, University Hospital of Zurich, Zurich, Switzerland
- Neurology, University Hospital of Zurich, Zurich, Switzerland
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7
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Fortunato PN, Ueno DTY, Sukessada MS, Barros GS, Silva JFCPD, Freire BF, Gulhote DA, Piffer ABB, Silva Junior HMD. Cefaléia e disfunção de nervos cranianos secundários a aneurisma de artéria carótida: relato de dois casos e revisão da literatura. HEADACHE MEDICINE 2022. [DOI: 10.48208/headachemed.2022.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
O seio cavernoso é um plexo venoso localizado na base do crânio. Várias patologias, como processos inflamatórios, aneurismáticos ou metastáticos, podem afetar esse plexo. A síndrome do seio cavernoso ocorre quando os nervos estão envolvidos nessa região (nervos cranianos III, IV, VI e divisões do V). Essas relações anatômicas explicam que a diplopia e a dor são os sintomas iniciais mais comuns nesses pacientes. Os aneurismas carotídeos cavernosos (CCAs) representam 2% a 9% dos aneurismas. Relatamos dois pacientes que apresentaram síndrome do seio cavernoso decorrente de aneurismas da artéria carótida. O reconhecimento da etiologia desse quadro clínico diferenciado é fundamental para evitar complicações e direcionar a melhor conduta para cada paciente.
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8
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Ding M, Wang X, Zhao H, Shi M, Shang Y, Wang H, Wang X, Tong X. Internal carotid artery constriction with or without superficial temporal artery-middle cerebral artery bypass for patients with giant internal carotid aneurysms. World Neurosurg 2022; 164:e662-e670. [DOI: 10.1016/j.wneu.2022.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/08/2022] [Indexed: 10/18/2022]
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9
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Abstract
BACKGROUND With the development of bypass technique, more and more complex aneurysms can be treated with bypass surgery. The goal of this study is to evaluate the efficacy and safety of bypass in patients with giant cavernous carotid aneurysms (GCCAs). To further discuss the treatment of asymptomatic GCCAs. METHODS The authors retrospectively reviewed our experience of the internal carotid artery (ICA) ligation/constriction combined with high/low-flow bypass surgery in the treatment of GCCAs. RESULTS Among the entire cohort, 4 patients underwent ICA ligation combined with high-flow bypass, 7 patients underwent ICA ligation/constriction combined with low-flow bypass. The postoperative symptom improvement: of 9 patients with preoperative ophthalmoplegia, the symptom resolved in 2 patients, improved in 7 patients, of 7 patients with preoperative pain, the symptom resolved in 2 patients, improved in 4 patients and was unchanged in 1 patient. The results of following-up were measured using the modified Rankin scale (mRS). During the follow-up, there were 9 patients with mRS score 0 to 1, 1 patient with mRS score 2, and 1 patient with mRS score 3. The long-term graft patency rate was 100%. All patients had no recurrence of intracranial aneurysm. CONCLUSIONS Bypass surgery is a safe and effective method to treat GCCAs. Because of the risk of GCCAs and the improvement of bypass surgery technology, active surgical strategies should be adopted for asymptomatic or mild symptomatic GCCAs.
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10
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Ahmed O, Mahmood S, Aladham Y, Abdelnaby MM. Traumatic pseudoaneurysm of the cavernous carotid: a lethal complication of craniofacial trauma. J Surg Case Rep 2020; 2020:rjaa500. [PMID: 33391640 PMCID: PMC7769192 DOI: 10.1093/jscr/rjaa500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 11/04/2020] [Indexed: 11/14/2022] Open
Abstract
Pseudoaneurysm of the cavernous carotid artery is a rare, yet life-threatening complication of craniofacial trauma. It may well present itself with delayed massive epistaxis up to several months after the initial insult. Early recognition and prompt treatment are the key in management and a high index of clinical suspicion is always required. In this article, we report a patient with a penetrating head injury who developed delayed epistaxis along with unilateral abducent and partial oculomotor palsy. Urgent diagnostic carotid angiography was undertaken, followed by endovascular coiling that resulted in no recurrence for a year of follow-up.
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Affiliation(s)
- Omar Ahmed
- Department of Otolaryngology, East Kent Hospitals University NHS Foundation Trust, Kent, UK
| | - Sara Mahmood
- Department of Otolaryngology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Youssef Aladham
- Department of Otolaryngology and Head and Neck Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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11
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Kumar A, Sharma RK, Tanaka R, Yamada Y, Takizawa K, Kato Y. High-Flow Bypass with Radial Artery Graft for Cavernous Carotid Aneurysm. Asian J Neurosurg 2020; 15:678-682. [PMID: 33145227 PMCID: PMC7591167 DOI: 10.4103/ajns.ajns_82_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/01/2020] [Accepted: 04/29/2020] [Indexed: 11/04/2022] Open
Abstract
Cavernous carotid aneurysms can be managed by different surgical as well as endovascular methods. The aim of treatment is to exclude the aneurysm from circulation and maintain normal cerebral blood flow. We are reporting a case of incidentally detected CCA managed by high flow bypass with radial artery graft. We discuss the surgical technique and nuances of high flow bypass surgery.
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Affiliation(s)
- Ambuj Kumar
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | | | - Riki Tanaka
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Yashuhiro Yamada
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Katsumi Takizawa
- Department of Neurosurgery, Japanese Red Cross Asahikawa Hospital, Asahikawa, Hokkaido, Japan
| | - Yoko Kato
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
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12
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Chauhan RS, Kathrani NV, Kulanthaivelu K, Prasad C, Gupta AK. Cavernous carotid artery large aneurysm treated with a new flow diverter – Xcalibur aneurysm occlusion device (AOD). Interv Neuroradiol 2020; 26:586-592. [DOI: 10.1177/1591019920951314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report a case of an unruptured, symptomatic, large right cavernous internal carotid artery aneurysm successfully treated with a new balloon-expandable flow diverter – Xcalibur Aneurysm Occlusion Device (AOD). Follow up imaging performed at six months demonstrated complete exclusion of the aneurysm and regression in dimensions, resulting in resolution of mass effect and clinical improvement.
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Affiliation(s)
- Richa Singh Chauhan
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Nihar Vijay Kathrani
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Karthik Kulanthaivelu
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Chandrajit Prasad
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Arun Kumar Gupta
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India
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13
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Castaño-Leon AM, Alen JF, Lagares A. Opening of unusual vascular collaterals leads to early recanalization of a giant intracavernous carotid artery aneurysm following common carotid artery occlusion: A Case report and literature review. Surg Neurol Int 2020; 11:62. [PMID: 32363057 PMCID: PMC7193203 DOI: 10.25259/sni_597_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/12/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Parent artery occlusion (PAO) with or without bypass surgery is a feasible treatment for large intracavernous carotid artery (ICCA) aneurysms. The ideal occlusion site (internal or common carotid artery [CCA]) and ischemic complications after PAO have received special attention since the description of the technique. Unfrequently, some patients can also develop unusual external carotid artery-internal carotid artery collateral pathways distal to the ligation site that can explain the failure to aneurysm size reduction. Case Description: We describe a rare case of delayed refilling of a large ICCA aneurysm partially thrombosed which early recanalized after surgical ligation of the cervical CCA through an unusual collateral pathway. Conclusion: Based on our experience, we recommend periodic long-term follow-up neuroimaging, especially in those cases where potential collateral branches have not been clearly identified in the preoperative studies.
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Affiliation(s)
- Ana M Castaño-Leon
- Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Avda Cordoba SN, Madrid, Spain
| | - Jose F Alen
- Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Avda Cordoba SN, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Avda Cordoba SN, Madrid, Spain
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14
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Miyatani K, Korde P, Yamada Y, Kawase T, Takizawa K, Kato Y. Atypical Symptomatic Bilateral Spontaneous Cavernous Carotid Aneurysm with Systemic Vessel Wall Pathology in Young Female: A Rare Case Report. Asian J Neurosurg 2019; 14:1245-1248. [PMID: 31903372 PMCID: PMC6896650 DOI: 10.4103/ajns.ajns_210_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Bilateral cavernous carotid aneurysm (CCA) is a rare entity. Its association with connective tissue disorder makes the diagnosis and treatment of symptomatic patient an enigma. We present a case report of a 25-year-old female medical student presented to us with bilateral spontaneous atypically symptomatic CCA with incidentally diagnosed case of Ehlers–Danlos syndrome. Both surgical and endovascular options of treatment were weighed and were ultimately treated satisfactorily by high-flow bypass with carotid artery ligation with an insurance bypass.
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Affiliation(s)
- Kyosuke Miyatani
- Department of Neurosurgery, Banbutane Hotokukai Hospital, Fujita Health University, Nagoya, Aichi, Japan
| | - Paresh Korde
- Department of Neurosurgery, Banbutane Hotokukai Hospital, Fujita Health University, Nagoya, Aichi, Japan
| | - Yasuhiro Yamada
- Department of Neurosurgery, Banbutane Hotokukai Hospital, Fujita Health University, Nagoya, Aichi, Japan
| | - Tsukasa Kawase
- Department of Neurosurgery, Banbutane Hotokukai Hospital, Fujita Health University, Nagoya, Aichi, Japan
| | - Katsumi Takizawa
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Yoko Kato
- Department of Neurosurgery, Banbutane Hotokukai Hospital, Fujita Health University, Nagoya, Aichi, Japan
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15
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Kobets AJ, Scoco A, Nakhla J, Brook AL, Kinon MD, Baxi N, Altschul D. Flow-Diverting Stents for the Obliteration of Symptomatic, Infectious Cavernous Carotid Artery Aneurysms. Oper Neurosurg (Hagerstown) 2019; 14:681-685. [PMID: 28961750 DOI: 10.1093/ons/opx166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 06/30/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Intracavernous aneurysms constitute up to 9% of all intracranial aneurysms and 6% are infectious (IIA). First line therapy is a protracted antibiotic course, yet with failure, surgery and endovascular parent vessel sacrifice have been utilized. Reconstructive endovascular therapies have emerged for aneurysm control and may demonstrate a safer therapeutic alternative. OBJECTIVE To present an IIA treated with a flow-diverting Pipeline stent (ev3 Neurovascular, Irvine, California). METHODS A 41-yr-old female presented with visual loss, ophthalmoplegia, and cavernous sinus thrombosis with an associated phlegmon. Transsphenoidal evacuation was performed without complication or bleeding and she continued on medical therapy. Two weeks postoperatively, she developed a worsening right third cranial nerve palsy and MRA demonstrated a 1-cm right IIA, not evident on postoperative MRI. Three days of dual antiplatelet therapy preceded successful pipeline embolization. Angiography demonstrated aneurysm obliteration at 3 mo and her right ophthalmoplegia resolved. RESULTS A literature review identified 6 reported cases of IIAs treated with stent embolization. Only 1 documented a flow-diverting Silk stent used in a child. All lesions were obliterated at follow-up without neurological sequelae. No complication arose with implantation in the setting of infection, and as few as 3 d of dual antiplatelet therapy was sufficient for preprocedural prophylaxis, although in Vivo antiplatelet activity may be more significant. CONCLUSION We report the first case of an IIA treated with a flow-diverting pipeline stent. These devices preserve native vasculature and neurological function compared to surgical and endovascular vessel sacrifice strategies. They appear to be safe management options for the treatment of IIAs.
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Affiliation(s)
- Andrew Joshua Kobets
- Leo M. Davidoff Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Aleka Scoco
- Leo M. Davidoff Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Jonathan Nakhla
- Leo M. Davidoff Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Allan Leonard Brook
- Leo M. Davidoff Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.,Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Merritt Drew Kinon
- Leo M. Davidoff Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Nrupen Baxi
- Leo M. Davidoff Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - David Altschul
- Leo M. Davidoff Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
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A Retrospective Analysis of Treatment Outcomes of 40 Incidental Cavernous Carotid Aneurysms. World Neurosurg 2019; 130:e1034-e1040. [DOI: 10.1016/j.wneu.2019.07.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 11/22/2022]
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17
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Junior JR, Oliveira LM, Boechat AL, Teixeira MJ, Figueiredo EG. Cavernous carotid artery aneurysms on a single institution: An epidemiological study with 201 patients. Clin Neurol Neurosurg 2019; 186:105504. [PMID: 31499419 DOI: 10.1016/j.clineuro.2019.105504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/19/2019] [Accepted: 08/26/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Cavernous carotid aneurysms (CCA) represent 2-9% of all intracranial aneurysms. For long considered benign lesions, these entities are unique when it comes to clinical presentation and management. Usually asymptomatic, CCAs can grow and rupture causing different manifestations. The lack of a long-term assessment of both treated and untreated CCAs' natural history justifies why there is no consensus regarding what are the recommended therapeutic measures. While some advocate that an intervention is always necessary, others consider that patients deserve an individualized evaluation. PATIENTS AND METHODS We describe our single-institution experience in diagnosis, follow-up, and management of 201 CCAs. In addition, we evaluate the association of giant CCAs with aneurysms in other locations using a Chi-square test. RESULTS 201 patients had 245 CCAs. 92% of the patients were women. The mean age at diagnosis was 61 years. Concomitant aneurysms were observed in 53.2% of the patients, and the middle cerebral artery was the most affected artery. 66 (30.6%) CCAs were considered "giant", and the follow-up period ranged from 1 to 23 years.The presence of a giant CCA seemed to hinder other aneurysms' formation - RR 0.47 (IC 95% 0.31-0.67), p < 0.0001. CONCLUSIONS CCAs should be individually assessed. A conservative approach ought to be adopted for asymptomatic and oligosymptomatic lesions. Finally, a multidisciplinary team must evaluate the other situations, in order to define whether the microsurgical or the endovascular treatment is better option. Presence of a giant lesion within the cavernous sinus is associated with less occurrence of other aneurysms.
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Affiliation(s)
- Jefferson Rosi Junior
- Department of Neurology, Division of Neurosurgery, School of Medicine, University of São Paulo (FMUSP), São Paulo, SP, Brazil
| | | | - Antonio Luiz Boechat
- Department of Parasitology, School of Medicine, Federal University of Amazonas (UFAM), Manaus, AM, Brazil
| | - Manoel Jacobsen Teixeira
- Department of Neurology, Division of Neurology, School of Medicine, University of São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Eberval Gadelha Figueiredo
- Department of Neurology, Division of Neurology, School of Medicine, University of São Paulo (FMUSP), São Paulo, SP, Brazil.
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Abstract
Cavernous carotid aneurysms (CCA) pose considerable dilemmas in management. It is still unclear as to whether an asymptomatic CCA should be subjected to treatment. Similarly, the ideal management strategy for a symptomatic aneurysm is controversial. We present the case of a 60-year-old female with a giant CCA and discuss the management issues.
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Affiliation(s)
- Sudha Menon
- Department of Ophthalmology, Kasturba Medical College, Manipal, Karnataka, India
| | - R Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal, Karnataka, India
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Kikkawa Y, Kayahara T, Teranishi A, Shibata A, Suzuki K, Kamide T, Ikeda T, Kurita H. Predictors of the Resolution of Cavernous Sinus Syndrome Caused by Large/Giant Cavernous Carotid Aneurysms After Parent Artery Occlusion with High-Flow Bypass. World Neurosurg 2019; 132:e637-e644. [PMID: 31442640 DOI: 10.1016/j.wneu.2019.08.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the clinical results and factors related to the resolution of preoperative cranial neuropathy after internal carotid artery ligation with high-flow bypass in patients with symptomatic large or giant cavernous carotid aneurysms. METHODS This study included 18 consecutive patients (15 women) with cranial neuropathy. All patients underwent therapeutic internal carotid artery ligation with high-flow bypass using a radial artery graft. Patient demographics, duration of symptoms, clinical outcomes, complications, and radiographic findings were retrospectively analyzed. The mean follow-up period was 31.0 months (range: 3-74 months). RESULTS Patients' mean age was 66.6 years, and the mean aneurysm size was 23.7 mm. Six patients (33%) had partially thrombosed aneurysms. Preoperatively, 16 (89%) and 8 (44%) patients presented with ophthalmoplegia and facial pain, respectively. Bypass patency was confirmed in 15 patients (83%), and obliteration of the aneurysm was confirmed in all patients at the final follow-up. Preoperative ophthalmoplegia resolved in 10 patients (63%), and trigeminal pain resolved in all patients. Postoperative resolution of patients' ophthalmoplegia was significantly associated with age (P = 0.044), symptom duration before treatment (P = 0.042), and the degree of ophthalmoplegia (P = 0.046). The degree of postoperative residual ophthalmoplegia was positively correlated with the duration of ophthalmoplegia from onset to surgery (r = 0.619; P = 0.011). Preoperative trigeminal pain resolved regardless of the preoperative duration of this symptom in all patients. CONCLUSIONS Early treatment is recommended when treating large or giant cavernous carotid aneurysms with cranial neuropathy. Complete resolution is possible in younger patients with partial neuropathy.
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Affiliation(s)
- Yuichiro Kikkawa
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan; Department of Neurosurgery, Saitama Prefecture Cardiovascular and Respiratory Center, Saitama, Japan.
| | - Tomomichi Kayahara
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Akio Teranishi
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Aoto Shibata
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan; Department of Neurosurgery, Saitama Prefecture Cardiovascular and Respiratory Center, Saitama, Japan
| | - Kaima Suzuki
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Tomoya Kamide
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Toshiki Ikeda
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hiroki Kurita
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
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Ghorbani M, Hejazian SE, Dastmalchi A, Chavoshinejad M, Asaadi S. Orbital Compartment Syndrome Secondary to Direct Carotid Cavernous Fistula After Carotid Cavernous Aneurysm Rupture: Case Report and Review of Literature. World Neurosurg 2019; 133:409-412. [PMID: 31421298 DOI: 10.1016/j.wneu.2019.08.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Carotid cavernous aneurysm (CCA) rupture is rare. However, it can result in various complications such as carotid cavernous fistula (CCF), epistaxis, spontaneous thrombosis, and subarachnoid hemorrhage. CASE DESCRIPTION We report a 65-year-old woman with a history of uncontrolled diabetes who was referred with complaints of acute headache, diplopia, proptosis, and chemosis. Ophthalmic examination revealed elevated intraocular pressure in the right eye, optic disk edema, and retinal venous congestion. Canthotomy was performed based on a diagnosis of orbital compartment syndrome (OCS). Further imaging revealed a dilated superior ophthalmic vein and cavernous sinus, as well as swelling of the extraocular muscles in the right eye. Digital subtraction angiography revealed the fistulous connection between the cavernous part of the internal carotid and cavernous sinus (direct CCF) due to the large ruptured CCA, resulting in retrograde flow through the superior and inferior ophthalmic veins. Successful endovascular coiling of the aneurysm resulted in complete occlusion of the fistula. Postintervention ophthalmic examination demonstrated progressive improvement of ophthalmic signs and symptoms; however, the patient's right eye remained sightless. CONCLUSIONS In patients with clinical manifestation of OCS with no history of any predisposing risk factors, diagnosis of ruptured cavernous sinus aneurysm and resulting direct CCF should be considered. In such cases, emergent imaging along with early endovascular intervention can resolve OCS and prevent permanent ocular injury and vision loss.
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Affiliation(s)
- Mohammad Ghorbani
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Tehran, Iran
| | | | - Alireza Dastmalchi
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Tehran, Iran
| | - Mehdi Chavoshinejad
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Tehran, Iran
| | - Sina Asaadi
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Tehran, Iran; Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Rattananon P, Saowapa S, Sriphrapradang C. Pituitary crush. Endocrine 2019; 64:420-421. [PMID: 30771151 DOI: 10.1007/s12020-019-01866-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 02/06/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Parin Rattananon
- Faculty of Medicine Ramathibodi Hospital, Department of Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Sakditad Saowapa
- Faculty of Medicine Ramathibodi Hospital, Department of Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Chutintorn Sriphrapradang
- Faculty of Medicine Ramathibodi Hospital, Department of Medicine, Mahidol University, Bangkok, 10400, Thailand.
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22
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Menon G, Menon S, Hegde A. Does Universal Bypass before Carotid Artery Occlusion Obviate the Need for Balloon Test Occlusion: Personal Experience with Extracranial-Intracranial Bypass in 23 Patients. J Neurosci Rural Pract 2019; 10:194-200. [PMID: 31001004 PMCID: PMC6454976 DOI: 10.4103/jnrp.jnrp_381_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aim Carotid artery ligation carries a potential risk of ischemic complications even in patients with good collaterals and adequate cross-circulation. Preoperative assessment through balloon test occlusion (BTO) is technically challenging and not feasible in all patients. We analyze our experience with universal bypass without performing detailed cerebrovascular reserve (CVR) studies in 23 patients before carotid artery ligation. Patients and Methods This was a retrospective analysis of the case records of 23 patients who underwent cervical carotid artery ligation for various indications since January 2009. Results The study included 21 patients with cavernous carotid aneurysms, one patient with a large fusiform petrous carotid aneurysm, and one patient with recurrent glomus jugulare encasing the cervical internal carotid artery. The initial 12 patients underwent preoperative BTO with hypotensive challenge. All patients underwent a bypass procedure followed by carotid artery ligation irrespective of the BTO findings. Patients who successfully completed a BTO underwent a low-flow superficial temporal artery to middle cerebral artery bypass. A high-flow extracranial-intracranial bypass using a saphenous vein graft from external carotid artery to middle cerebral artery was done in all patients who either failed the BTO or did not undergo BTO. We had two operative mortalities and one poor outcome. All the other patients had a good recovery with a Glasgow outcome score of 5 at the last follow-up. Graft patency rates were 81.1% in both the low-flow and high-flow groups. Conclusion Universal high-flow bypass is safe, effective, and should be preferred in all patients before carotid artery ligation. It obviates the need for detailed CVR assessment, especially in centers with limited resources.
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Affiliation(s)
- Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal, Karnataka, India
| | - Sudha Menon
- Department of Ophthalmology, Kasturba Medical College, Manipal, Karnataka, India
| | - Ajay Hegde
- Department of Neurosurgery, Kasturba Medical College, Manipal, Karnataka, India
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23
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Hsu CC, Tsai SH, Wang JC, Kao HW, Hsu CW, Liu WH, Chen SJ. Swollen and bloodshot eye following headache. Am J Emerg Med 2018; 37:378.e7-378.e9. [PMID: 30415985 DOI: 10.1016/j.ajem.2018.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 11/05/2018] [Indexed: 11/24/2022] Open
Abstract
A ruptured cavernous carotid aneurysm (CCA) with carotid cavernous fistula can appear as a benign headache but progress to a swollen and bloodshot eye overnight. A 66-year-old woman visited emergency department with sudden onset of pain behind her left forehead and vomiting. She was treated for a migraine-like headache and discharged. She presented again on the next day with a persistent headache and a swollen left eye with blurred vision. An ophthalmologic examination revealed erythema of the left lid and chemosis at the temporal and lower bulbar conjunctiva. A cranial nonenhanced computed tomography (CT) scan had been performed at her previous visit. The scan exhibited a nodular mass lesion involving the left cavernous sinus. CT angiography was subsequently used to determine that the lesion was a giant aneurysm in the left cavernous internal carotid artery, causing enlargement of the left ophthalmic veins. The symptoms of her left eye rapidly progressed to severe chemosis, edematous change over periocular region, and limited movements after 8 h. The patient received emergent lateral canthotomy and inferior cantholysis to avoid acute orbital compartment syndrome and was subsequently treated with stent-assisted coil embolization. A ruptured CCA is an urgent condition that requires rapid assessment of both cranial vascular and ocular lesions. A history of sudden onset headache with a nonpainful acute unilateral red eye may serve as a clue to prompt additional diagnostic studies and ophthalmologist evaluation. Adequate radiological studies and early endovascular intervention can reduce the likelihood of permanent ocular injury and vision impairment.
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Affiliation(s)
- Chia-Cheng Hsu
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Hung Tsai
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jen-Chun Wang
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hung-Wen Kao
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chin-Wang Hsu
- Department of Emergency Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wei-Hsiu Liu
- Department of Neurosurgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Sy-Jou Chen
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Abstract
Cavernous carotid aneurysms (CCAs) pose considerable dilemmas in management. Delayed post-traumatic epistaxis is a rare presentation of CCA. Clinically, the symptomatic triad of unilateral blindness, orbital fractures, and massive epistaxis is pathognomonic for internal carotid artery (ICA) pseudoaneurysm. The epistaxis is usually profound, intermittent, and life-threatening in nature. As most of these cases are initially seen by a physician, a high index of suspicion is essential during its early identification. Traumatic aneurysms are pseudoaneurysms with a fibrous wall that rupture and cause massive epistaxis resulting from disruption through the sphenoid sinus wall. We report a young adult who presented with the triad and severe anemia four months following head injury. He was treated with ligation of the carotid artery and a high-flow extracranial-intracranial (EC-IC) bypass. In the era of endovascular coiling and flow diverters, EC-IC bypass still has a role in the treatment of complex giant aneurysms with comparable results.
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Affiliation(s)
- Girish Menon
- Neurosurgery, Kasturba Medical College, Manipal, IND
| | - Ajay Hegde
- Neurosurgery, Kasturba Medical College, Manipal, IND
| | - Rajesh Nair
- Neurosurgery, Kasturba Medical College, Manipal, IND
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25
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High-Flow Extracranial–Intracranial Bypass for Giant Cavernous Carotid Aneurysm. J Craniofac Surg 2018; 29:1042-1046. [DOI: 10.1097/scs.0000000000004422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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26
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Vanikieti K, Poonyathalang A, Jindahra P, Cheecharoen P, Chokthaweesak W. Occipital lobe infarction: a rare presentation of bilateral giant cavernous carotid aneurysms: a case report. BMC Ophthalmol 2018; 18:25. [PMID: 29394920 PMCID: PMC5797379 DOI: 10.1186/s12886-018-0687-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/19/2018] [Indexed: 11/24/2022] Open
Abstract
Background Cavernous carotid aneurysm (CCA) represents 2–9% of all intracranial aneurysms and 15% of internal carotid artery (ICA) aneurysms; additionally, giant aneurysms are those aneurysms that are > 25 mm in size. Bilateral CCAs account for 11–29% of patients and are commonly associated with structural weaknesses in the ICA wall, secondary to systemic hypertension. CCAs are considered benign lesions, given the low risk for developing major neurologic morbidities (i.e., subarachnoid hemorrhage, cerebral infarction, or carotid cavernous fistula). Moreover, concurrent presentation with posterior circulation cerebral infarction is even rarer, given different circulation territory from CCA. Here, we report on a patient with bilateral giant CCAs who presented with both typical and atypical symptoms. Case presentation An 88-year-old hypertensive woman presented with acute vertical oblique binocular diplopia, followed by complete ptosis of the right eye. Ophthalmic examination showed dysfunction of the right third, fourth, and sixth cranial nerves. Further examination revealed hypesthesia of the areas supplied by the ophthalmic (V1) and maxillary (V2) branches of the right trigeminal nerve. Bilateral giant cavernous carotid aneurysms, with a concurrent subacute right occipital lobe infarction, were discovered on brain imaging and angiogram. Additionally, a prominent right posterior communicating artery (PCOM) was revealed. Seven months later, clinical improvement with stable radiographic findings was documented without any intervention. Conclusions Dysfunction of the third, fourth, and sixth cranial nerves, and the ophthalmic (V1) and maxillary (V2) branches of the trigeminal nerves, should necessitate brain imaging, with special attention given to the cavernous sinus. Despite unilateral symptomatic presentation, bilateral lesions cannot be excluded solely on the basis of clinical findings. CCA should be included in the differential diagnosis of cavernous sinus lesions. Although rare, ipsilateral posterior circulation cerebral infarction (i.e., occipital lobe infarction) can occur in CCA patients, presumably as a result of distal embolization through an ipsilateral, prominent PCOM. Spontaneous clinical improvement with stable radiographic support may occur.
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Affiliation(s)
- Kavin Vanikieti
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok, 10400, Thailand
| | - Anuchit Poonyathalang
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok, 10400, Thailand
| | - Panitha Jindahra
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok, 10400, Thailand
| | - Piyaphon Cheecharoen
- Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok, 10400, Thailand
| | - Wimonwan Chokthaweesak
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok, 10400, Thailand.
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27
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Liu Y, Shi X, Liu F, Sun Y, Qian H, Lei T. Bilateral cavernous carotid aneurysms treated by two-stage extracranial-intracranial bypass followed by parent artery occlusion: case report and literature review. Acta Neurochir (Wien) 2017; 159:1693-1698. [PMID: 28181086 DOI: 10.1007/s00701-017-3101-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
Abstract
Bilateral cavernous carotid aneurysms (CCAs) are often not amenable to neurosurgical clipping or endovascular coiling. Here, we report the case of a 50-year-old female who presented with a 1-year history of gradual severe headache. Preoperative angiograms revealed bilateral CCAs. Among these findings, the right giant CCA had been trapped after the external carotid artery-saphenous vein-middle cerebral artery (ECA-SV-MCA) bypass 8 years prior. Additionally, the left CCA was again trapped after the internal maxillary artery-radial artery-middle cerebral artery (IMA-RA-MCA) bypass, followed by parent artery occlusion (PAO), because of the enlargement of a 0.4-cm aneurysm to a 1.3-cm aneurysm during the 5th to 8th years following surgery. Postoperative radiologic findings proved that the aneurysms disappeared with good graft patency of the bilateral anastomoses and excellent filling of the bilateral MCA territories. This is the first case of bilateral CCAs treated with two stages of bilateral high-flow extracranial-intracranial (EC-IC) bypass, including an IMA-RA-MCA bypass.
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28
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Raper DMS, Ding D, Peterson EC, Crowley RW, Liu KC, Chalouhi N, Hasan DM, Dumont AS, Jabbour P, Starke RM. Cavernous carotid aneurysms: a new treatment paradigm in the era of flow diversion. Expert Rev Neurother 2016; 17:155-163. [DOI: 10.1080/14737175.2016.1212661] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Daniel M. S. Raper
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA
| | - Dale Ding
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA
| | - Eric C. Peterson
- Department of Neurosurgery, University of Miami Miller School of Medicine, University of Miami Hospital, Jackson Memorial Hospital, Miami Children’s Hospital, Miami, FL, USA
| | | | - Kenneth C. Liu
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA
| | - Nohra Chalouhi
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - David M. Hasan
- Department of Neurological Surgery, University of Iowa, Iowa City, IA, USA
| | - Aaron S. Dumont
- Department of Neurological Surgery, Tulane University, New Orleans, LA, USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Robert M. Starke
- Department of Neurosurgery, University of Miami Miller School of Medicine, University of Miami Hospital, Jackson Memorial Hospital, Miami Children’s Hospital, Miami, FL, USA
- Department of Radiology, University of Miami Miller School of Medicine, University of Miami Hospital and Jackson Memorial Hospital, Miami, FL, USA
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29
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Boiko NV, Batueva VA. Epistaxis from posttraumatic aneurysm of the internal carotid artery. ACTA ACUST UNITED AC 2016. [DOI: 10.17116/rosrino201624130-34] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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30
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Munich SA, Cress MC, Levy EI. Flow Diversion for the Treatment of Intracranial Aneurysms. Neurosurgery 2015; 62 Suppl 1:50-5. [DOI: 10.1227/neu.0000000000000804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Stephan A. Munich
- Department of Neurosurgery
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - Marshall C. Cress
- Department of Neurosurgery
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - Elad I. Levy
- Department of Neurosurgery
- Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
- Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York
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31
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Nishino K, Hasegawa H, Ito Y, Fujii Y. Bilateral Cavernous Carotid Aneurysms: The Growth Potential of a Contralateral Aneurysm after Therapeutic Unilateral Internal Carotid Artery Occlusion. J Stroke Cerebrovasc Dis 2015; 24:1865-72. [PMID: 26104242 DOI: 10.1016/j.jstrokecerebrovasdis.2015.04.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 04/11/2015] [Accepted: 04/17/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Although the introduction of flow-diverter stents has been recognized as a major revolution in the treatment of cavernous carotid aneurysms (CCAs), therapeutic internal carotid artery occlusion (TICAO) remains a reliable procedure for alleviating symptoms caused by CCAs. However, TICAO has the potential risk of the enlargement of coexisting aneurysms that are frequently detected in CCA patients. The purpose of this study is to assess the occurrence of the enlargement of aneurysms coexisting with CCAs after TICAO. METHODS We reviewed medical charts of CCA patients who were managed using unilateral TICAO. Coexisting aneurysms were identified using angiograms obtained before TICAO, and imaging data in long follow-up periods were retrospectively examined to determine the extent of the enlargement after TICAO. RESULTS Of 12 patients with CCAs, 10 had 12 coexisting aneurysms; 5 of the coexisting aneurysms (41.7%) showed enlargement during a mean follow-up period of 8.1 years, and all enlarged aneurysms were smaller of the bilateral CCAs; the larger CCA had been managed by TICAO. Five of 6 (83.3%) patients with bilateral CCAs showed enlargement of the contralateral aneurysm after TICAO. Two contralateral CCAs showed marked enlargement after TICAO and were subsequently treated with stent-assisted coil embolization. CONCLUSIONS Contralateral, smaller aneurysms frequently enlarge after unilateral TICAO in patients with bilateral CCAs. The findings emphasize the importance of long-term observation after TICAO and appropriate interventions against enlarging contralateral aneurysms.
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Affiliation(s)
- Kazuhiko Nishino
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan.
| | - Hitoshi Hasegawa
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Yasushi Ito
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Yukihiko Fujii
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
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Uozumi Y, Okamoto S, Araki Y, Izumi T, Matsubara N, Yokoyama K, Sumitomo M, Miyachi S, Wakabayashi T. Treatment of Symptomatic Bilateral Cavernous Carotid Aneurysms: Long-term Results of 6 Cases. J Stroke Cerebrovasc Dis 2015; 24:1013-8. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.12.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 12/19/2014] [Accepted: 12/22/2014] [Indexed: 11/17/2022] Open
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