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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Chu F, Song M, Zhang Z, Pang C, Wang J. Sacrificing Internal Carotid Artery-External Carotid Artery-Radial Artery-Middle Cerebral Artery Bypass for the Treatment of Complex Intracranial Artery Cavernous Sinus Aneurysms. J Craniofac Surg 2024:00001665-990000000-01396. [PMID: 38451102 DOI: 10.1097/scs.0000000000010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 12/06/2023] [Indexed: 03/08/2024] Open
Abstract
The treatment of complex intracranial aneurysms has always been a great challenge in neurosurgery. Craniotomy has a high risk of clipping, there is a risk of rupture at any time, endovascular embolization is relatively low risk, but expensive and easy to relapse, the best treatment needs to be further discussed. Cavernous sinus aneurysms with pituitary adenomas are rare. This case reports a case of complex intracranial aneurysms. Chief complaints are: (1) blepharoptosis with blurred vision for 1 year, (2) headache for 3 days, and (3) digital subtraction angiography showed right internal carotid artery cavernous sinus aneurysm. Combined with the patient's condition and family condition, the external carotid artery-radial artery-middle cerebral artery bypass was selected. After surgical treatment, the symptoms of the patients were improved, the postoperative recovery was good, and the condition was stable. After follow-up, the patient's brain computed tomography showed intra-aneurysm thrombosis.
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Affiliation(s)
- Fudi Chu
- School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong
| | - MaoYuan Song
- School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong
| | - Zheng Zhang
- School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong
| | - Chunxiao Pang
- Department of Neurosurgery, Weifang People's Hospital Affiliated to Weifang Medical University, Weifang, China
| | - JinPeng Wang
- Department of Neurosurgery, Weifang People's Hospital Affiliated to Weifang Medical University, Weifang, China
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3
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Coburn W, Fonteh CN, Subramanian PS. Isolated Compressive Optic Neuropathy Due to Cavernous Carotid Aneurysms: A 2-Patient Case Report. J Neuroophthalmol 2023; 43:e237-e238. [PMID: 35471262 DOI: 10.1097/wno.0000000000001591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- William Coburn
- Departments of Ophthalmology (WC, CNF, PSS), Neurology (PSS), and Neurosurgery (PSS), University of Colorado School of Medicine and Sue Anschutz-Rodgers UCHealth Eye Center, Aurora, Colorado ; and Division of Ophthalmology (PSS), Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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4
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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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5
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Badrawi N, Alfalahi A, Mirza A, Al-Sibaie A. Giant cavernous internal carotid aneurysm presenting with dizziness and bradycardia: A case report and a review of literature. Radiol Case Rep 2023; 18:2090-2095. [PMID: 37089981 PMCID: PMC10113756 DOI: 10.1016/j.radcr.2023.02.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 04/09/2023] Open
Abstract
Giant cavernous carotid aneurysms are rare pathologic entities that are typically benign and are considered less life-threatening due to the low risk of rupture of bleeding. They present with clinical features usually due to localized mass effects on adjacent neural structures, mainly the III, IV, V, and VI cranial nerves. There are various treatment options, including occlusion of the feeding vessel, immediate surgery on the aneurysm, bypass procedures, and use of endovascular devices. We present a case of a 36-year-old male presented to the emergency department with 5 days history of right retro-orbital pain and diplopia. The patient's imaging workup revealed a right giant cavernous carotid aneurysm. Along with the conventional symptoms, physical examination revealed sinus bradycardia. Internal carotid artery occlusion was performed, and his symptoms gradually resolved.
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6
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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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Mathews B, Knight OJ. Carotid cavernous fistula secondary to ruptured carotid cavernous aneurysm causing orbital compartment syndrome. Am J Ophthalmol Case Rep 2022; 25:101310. [PMID: 35128158 PMCID: PMC8807974 DOI: 10.1016/j.ajoc.2022.101310] [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: 01/25/2021] [Revised: 04/28/2021] [Accepted: 01/18/2022] [Indexed: 11/02/2022] Open
Abstract
PURPOSE To report the rare presentation of orbital compartment syndrome secondary to formation of carotid cavernous fistula in the absence of trauma or surgery and demonstrate the role of emergent canthotomy/cantholysis as a vision saving procedure. OBSERVATIONS A 28-year-old African American female with obesity and migraines presented to the emergency department (ED) with the worst headache of her life after a severe episode of vomiting and dry heaving. Initial CT scan was negative for subarachnoid hemorrhage and patient was discharged. She re-presented to ED several days later with worsening proptosis and left eyelid edema and was discharged on oral antibiotics for presumed preseptal cellulitis after repeat CT scan. When seen by Ophthalmology in clinic, she was noted to have decreased vision, proptosis, decreased color perception, and double vision. She was noted to have orbital compartment syndrome requiring emergent canthotomy/cantholysis in the minor OR. She was sent back to ED for work-up, ultimately revealing a carotid cavernous fistula secondary to rupture of a carotid cavernous aneurysm. She was treated with several coil embolization procedures and ultimately her visual acuity rebounded to 20/20. CONCLUSIONS AND IMPORTANCE Orbital compartment syndrome may be a rare presentation of carotid cavernous fistula secondary to ruptured carotid cavernous aneurysm in the absence of trauma or surgery. Our case demonstrates the importance of properly assessing the cause of a red, edematous, proptosed eye in clinical setting and initiating an appropriate workup and treatment plan without delay.
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Affiliation(s)
- Basil Mathews
- Department of Ophthalmology, Kittner Eye Center at University of North Carolina, 2226 Nelson Highway, Chapel Hill, NC, USA
| | - O'Rese J Knight
- Department of Ophthalmology, Kittner Eye Center at University of North Carolina, 2226 Nelson Highway, Chapel Hill, NC, USA
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8
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Menezes V, Menezes R. Case report of unilateral abducens nerve paresis: A common sign with an uncommon etiology. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2022. [DOI: 10.4103/tjosr.tjosr_50_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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The diagnostic accuracy of MRI in determining the relations between paraclinoid aneurysms and the cavernous sinus. Neuroradiology 2021; 64:1175-1185. [PMID: 34821948 PMCID: PMC9117373 DOI: 10.1007/s00234-021-02864-y] [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: 09/16/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022]
Abstract
Purpose The location of paraclinoid aneurysms is determinant for evaluation of its intradural compartment and risk of SAH after rupture. Advanced MRI techniques have provided clear visualization of the distal dural ring (DDR) to determine whether an aneurysm is intracavernous, transitional or intradural for decision-making. We analyzed the diagnostic accuracy of MRI in predicting whether a paraclinoid aneurysm is intracavernous, transitional or intradural. Methods We conducted a prospective cohort between January 2014 and December 2018. Patients with paraclinoid aneurysms underwent 3D fast spin-echo MRI sequence before surgical treatment. The DDR was the landmark for MRI characterization of the aneurysms as follow: (i) Intradural; (ii) Transitional; and (iii) Intracavernous. The MRI sensitivity, specificity, positive and negative likelihood ratios were determined compared to the intraoperative findings. We also evaluated the intertechnique agreement using the Cohen’s kappa coefficient (κ) for dichotomous classifications (cavernous vs non-cavernous). Results Twenty patients were included in the cohort. The accuracy of MRI showed a sensitivity of 86.7% (95%CI:59.5–98.3) and specificity of 90.0% (95%CI:55.5–99.8). Analyzing only patients without history of SAH, accuracy test improved with a sensitivity of 92.3% (95%CI:63.9–99.8) and specificity reached 100% (95%CI: 63–100). Values of Cohen’s kappa (κ), intertechnique agreement was considered substantial for dichotomous classifications (κ = 0.754; p < 0.001). For patients without previous SAH, intertechnique agreement was even more coincident for the dichotomous classification (κ = 0.901; p < 0.001). Conclusion 3D fast spin-echo MRI sequence is a reliable and useful technique for determining the location of paraclinoid aneurysms in relation to the cavernous sinus, particularly for patients with no history of SAH.
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10
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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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11
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Rama Raj P, Smith V. Anatomical Basis of Clinical Manifestations Seen in Cavernous Sinus Syndrome: A Narrative Review. Open Ophthalmol J 2021. [DOI: 10.2174/1874364102115010070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pathology involving the Cavernous Sinus (CS), generally referred to as Cavernous Sinus Syndrome (CSS), can arise from vascular disorders, neoplasms, infections, and non-infectious inflammatory disorders. An acute understanding of the CS and its regional anatomical structures is therefore pertinent in expounding the highly variable clinical manifestations seen in CSS as well as laying the groundwork for surgical intervention. Though the neuroanatomy of the cavernous sinus has been substantially chronicled in literature, their correlation to clinical signs has only been minimally described. This narrative review serves to address this knowledge gap and aims to comprehensively correlate the clinical manifestations of CSS with the relevant neuroanatomy, thereby allowing medical practitioners to better navigate the diagnostic quandary. We conducted a scoping review of the literature concerning CS anatomy and CSS, complied through MEDLINE/OVID and cross-referencing of articles on PubMed and Google Scholar with the keywords cavernous sinus, cavernous sinus syndrome, clinical signs/manifestations, neuroanatomy, CS pathology, Cavernous Sinus Thrombus (CST) and cavernous sinus neoplasms/tumours.
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12
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Sattur M, Saway BF, Lena J, Spiotta A. Endovascular Management of a Giant Skull Base Cavernous Aneurysm: Parent Artery Occlusion Is Still a Relevant Strategy. Cureus 2021; 13:e13643. [PMID: 33824796 PMCID: PMC8012178 DOI: 10.7759/cureus.13643] [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] [Indexed: 11/17/2022] Open
Abstract
Cavernous carotid aneurysms (CCAs) are usually considered benign as the natural history of the condition is often asymptomatic; however, CCAs can reach giant proportions and become symptomatic, thus requiring treatment. The introduction of flow diverters has revolutionized management of this condition. However, the parent artery geometry in giant lesions may prove exceedingly difficult to navigate and deploy stents satisfactorily. In such cases, indirect surgical treatment such as proximal occlusion of internal carotid artery (ICA) should be employed. Preoperative balloon test occlusion is indicated before permanent occlusion to identify patients who demonstrate hemispheric ischemia (for possible bypass), but it requires understanding of important operative complications and technical nuances. Endovascular parent artery sacrifice is an effective modality to achieve proximal occlusion. Here, we describe the step-wise management approach in a 53-year-old female with a giant, left CCA presenting with headache and cavernous sinus syndrome who was ultimately successfully treated with endovascular coiling and ICA occlusion. The management of complex lesions such as giant skull base aneurysms requires a sound understanding of vascular anatomy, tools available for evaluation, and physiological interpretation of diagnostic and therapeutic modalities to obtain excellent clinical results and patient satisfaction.
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Affiliation(s)
- Mithun Sattur
- Department of Neurological Surgery, Medical University of South Carolina, Charleston, USA
| | - Brian F Saway
- Department of Neurological Surgery, Medical University of South Carolina, Charleston, USA
| | - Jonathan Lena
- Department of Neurological Surgery, Medical University of South Carolina, Charleston, USA
| | - Alejandro Spiotta
- Department of Neurological Surgery, Medical University of South Carolina, Charleston, USA
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13
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Tanaka R, Liew BS, Sasaki K, Miyatani K, Kawase T, Yamada Y, Kato Y, Horiguchi A. High-Flow Bypass with Radial Artery Graft for Cavernous Carotid Aneurysms: A Case Series. Asian J Neurosurg 2020; 15:863-869. [PMID: 33708655 PMCID: PMC7869276 DOI: 10.4103/ajns.ajns_289_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: 06/12/2020] [Revised: 06/27/2020] [Accepted: 07/29/2020] [Indexed: 11/19/2022] Open
Abstract
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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Affiliation(s)
- Riki Tanaka
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Boon Seng Liew
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Kento Sasaki
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Kyosuke Miyatani
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Tsukasa Kawase
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Yasuhiro Yamada
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Yoko Kato
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Akihiko Horiguchi
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, Nagoya, Japan
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14
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Feghali J, Gami A, Caplan JM, Tamargo RJ, McDougall CG, Huang J. Management of unruptured intracranial aneurysms: correlation of UIATS, ELAPSS, and PHASES with referral center practice. Neurosurg Rev 2020; 44:1625-1633. [PMID: 32700160 DOI: 10.1007/s10143-020-01356-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/02/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
Concordance between the Unruptured Intracranial Aneurysm Treatment Score (UIATS), Earlier Subarachnoid Hemorrhage, Location, Age, Population, Size, Shape (ELAPSS) score, and Population, Hypertension, Age, Size, Earlier Subarachnoid Hemorrhage, Site (PHASES) score with real-world management decisions in unruptured intracranial aneurysms (UIAs) remains unclear, especially in current practice. This study aimed to investigate this concordance, while developing an optimal model predictive of recent decision practices at a quaternary referral center. A prospective database of patients presenting with UIAs to our institution from January 1 to December 31, 2018, was used. Concordance between the scores and real-world management decisions on every UIA was assessed. Complications and length of stay (LOS) were compared between aneurysms in the UIATS-recommended treatment and observation groups. A subgroup analysis of concordance was also conducted among junior and senior surgeons. An optimal logistic regression model predictive of real-world decisions was also derived. The cohort consisted of 198 patients with 271 UIAs, of which 42% were treated. The UIATS demonstrated good concordance with an AUC of 0.765. Of the aneurysms in the UIATS-recommended "observation" group, 22% were discordantly treated. The ELAPSS score demonstrated good discrimination (AUC = 0.793), unlike the PHASES score (AUC = 0.579). Endovascular treatment rates, complications, and LOS were similar between aneurysms in the UIATS-recommended treatment and observation groups. Similar concordance was obtained among junior and senior surgeons. The optimal predictive model consisted of several significantly associated variables and had an AUC of 0.942. Cerebrovascular specialists may be treating aneurysms slightly more than these scores would recommend, independently of years in practice. Wide variation still exists in management practices of UIAs.
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Affiliation(s)
- James Feghali
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Abhishek Gami
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Justin M Caplan
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rafael J Tamargo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cameron G McDougall
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Johns Hopkins Hospital, 1800 Orleans Street, Sheikh Zayed Tower 6115F, Baltimore, MD, 21287, USA.
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15
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Munawar K, Nayak G, Fatterpekar GM, Sen C, Zagzag D, Zan E, Hagiwara M. Cavernous sinus lesions. Clin Imaging 2020; 68:71-89. [PMID: 32574933 DOI: 10.1016/j.clinimag.2020.06.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 11/16/2022]
Abstract
The cavernous sinus is a complex structure susceptible to a wide variety of vascular, neoplastic and inflammatory pathologies. Vascular pathologies include ICA aneurysms, carotid-cavernous fistulas, cavernous sinus thrombosis, and cavernous hemangioma. Neoplasms that involve the cavernous sinus include pituitary adenoma, meningioma, schwannoma, lymphoma, perineural tumor spread, metastases, and direct tumor invasion. Infectious and inflammatory diseases include Tolosa-Hunt syndrome, sarcoidosis, granulomatosis with polyangiitis, IgG-4 related disease and invasive fungal infections. In this article, we review the clinical and imaging findings of a number of pathologies involving the cavernous sinus, focusing on key features that can narrow the differential diagnosis and, in some cases, support a particular diagnosis.
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Affiliation(s)
- Kamran Munawar
- NYU Langone Health, Department of Radiology, New York, NY, United States of America
| | - Gopi Nayak
- NYU Langone Health, Department of Radiology, New York, NY, United States of America
| | - Girish M Fatterpekar
- NYU Langone Health, Department of Radiology, New York, NY, United States of America
| | - Chandra Sen
- NYU Langone Health, Department of Neurosurgery, New York, NY, United States of America
| | - David Zagzag
- NYU Langone Health, Department of Pathology, New York, NY, United States of America
| | - Elcin Zan
- NYU Langone Health, Department of Radiology, New York, NY, United States of America
| | - Mari Hagiwara
- NYU Langone Health, Department of Radiology, New York, NY, United States of America.
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Sun Y, Wan B, Li Q, Li T, Huang G, Zhang W, Yang J, Tong X. Endovascular Treatment for Cavernous Carotid Aneurysms: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2020; 29:104808. [PMID: 32305281 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Coiling and flow diversion are established endovascular techniques for treatment of cavernous carotid aneurysms (CCAs). We performed a systematic review of published series on endovascular treatment of CCAs in order to assess the efficacy and safety between coiling and flow diversion. METHODS We conducted a computerized search of PubMed, MEDLINE, and Web of Science electronic databases for reports on endovascular treatment of CCAs from 1990 to 2019. Comparisons were made in complete occlusion rate, improvement of symptoms rate and intraoperative complication rate between coiling and flow diversion. RESULTS Fourteen studies with 736 patients were included in this systematic review. Five hundred ninety-4 patients underwent coiling, 142 patients underwent flow diversion. The complete occlusion rate in the coiling group was significantly lower than that in the flow division group (odds ratio .37, 95%CI .16-.83, P < .00001), a forest plot did not reveal any significant differences in the improvement of symptoms rate or intraoperative complication rate following coiling and flow diversion. Complete occlusion rate was significantly lower in the coiling group (53%, 95%CI .40-.67) compared with the flow diversion group (74%, 95%CI .55-.94). Improvement of symptoms was significantly lower in the coiling group (54%, 95%CI .46-.63) compared with the flow diversion group (92%, 95%CI .85-.99). Coiling group had lower intraoperative complication rate (9%, 95%CI .06-.12) compared with flow division group (36%, 95%CI .25-.47). CONCLUSIONS Compared with coiling, the use of flow diversion for the treatment of CCAs may increase complete occlusion rate, and improvement of symptoms rate, but it also raised intraoperative complication rate. Due to the lack of high quality control research, further randomized controlled trials are needed to verify our conclusions.
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Affiliation(s)
- Yang Sun
- Department of Graduate School, Tianjin Medical University, Tianjin, China
| | - Benlin Wan
- Department of Graduate School, Nan Kai University, Tianjin, China
| | - Qi Li
- Department of Graduate School, Nan Kai University, Tianjin, China
| | - Tang Li
- Department of Graduate School, Tianjin Medical University, Tianjin, China
| | - Ge Huang
- Department of Graduate School, Tianjin Medical University, Tianjin, China
| | - Wenchao Zhang
- Department of Graduate School, Tianjin Medical University, Tianjin, China
| | - Jianghua Yang
- Department of Graduate School, Tianjin Medical University, Tianjin, China
| | - Xiaoguang Tong
- Department of Graduate School, Tianjin Medical University, Tianjin, China; Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China.
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Ting W, Richard SA, Changwei Z, Chaohua W, Xiaodong X. Concomitant occurrence of clinoid and cavernous segment aneurysms complicated with carotid cavernous fistula: A case report. Medicine (Baltimore) 2019; 98:e18184. [PMID: 31770272 PMCID: PMC6890289 DOI: 10.1097/md.0000000000018184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 10/10/2019] [Accepted: 10/30/2019] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Dual aneurysms arising from the internal cerotic artery (ICA) is a very rare occurrence. Clinoid segment aneurysms (CSAs) are often seen at the carotid dural rings while cavernous carotid aneurysms (CCAs) are often a direct communication between the ICA and the cavernous sinus (CS). We present a case of complex concomitant occurrence of a CSA and a CCA complicated with delay aneurysmal rupture (DAR) resulting in carotid cavernous fistula (CCF) after our initial treatment of the patient with pipeline embolization devices (PLEDs) PATIENT CONCERNS:: We present a 64-year old female who we admitted at our institution due to one-year history of double vision. Neurological examinations were unremarkable. DIAGNOSIS Magnetic resonance imaging (MRI) and computer tomography (CT)-scan revealed dual aneurysms on the ICA. Digital subtracting angiogram (DSA) confirmed a small CSA and a large CCA on the right ICA. INTERVENTIONS We treated both aneurysms with PLED and subsequently observed DAR of CCA as a complication. OUTCOMES We successfully occluded the fistula with ONYX (ev3, Irvine, CA) via the trans-venous approach. LESIONS PLED was the best endovascular treatment option though DAR was inevitable. Although the trans-arterial approach may be the gold standard for the managing of CCF, the complex nature of our case made us opt for trans-venous approach. The trans-venous route is very appropriate for fistulas with complex parent arteries.
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Affiliation(s)
- Wang Ting
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Seidu A. Richard
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
- Department of Medicine, Princefield University, Ho-Volta Region, Ghana
| | - Zhang Changwei
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Wang Chaohua
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Xie Xiaodong
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
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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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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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20
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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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21
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Mahalingam HV, Mani SE, Patel B, Prabhu K, Alexander M, Fatterpekar GM, Chacko G. Imaging Spectrum of Cavernous Sinus Lesions with Histopathologic Correlation. Radiographics 2019; 39:795-819. [DOI: 10.1148/rg.2019180122] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Harsha Vardhan Mahalingam
- From the Departments of Radiology (H.V.M., S.E.M.), Pathology (B.P., G.C.), Neurosurgery (K.P.), and Neurology (M.A.), Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu 632004, India; and the Department of Radiology, NYU Langone Medical Center, New York, NY (G.M.F.)
| | - Sunithi E. Mani
- From the Departments of Radiology (H.V.M., S.E.M.), Pathology (B.P., G.C.), Neurosurgery (K.P.), and Neurology (M.A.), Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu 632004, India; and the Department of Radiology, NYU Langone Medical Center, New York, NY (G.M.F.)
| | - Bimal Patel
- From the Departments of Radiology (H.V.M., S.E.M.), Pathology (B.P., G.C.), Neurosurgery (K.P.), and Neurology (M.A.), Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu 632004, India; and the Department of Radiology, NYU Langone Medical Center, New York, NY (G.M.F.)
| | - Krishna Prabhu
- From the Departments of Radiology (H.V.M., S.E.M.), Pathology (B.P., G.C.), Neurosurgery (K.P.), and Neurology (M.A.), Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu 632004, India; and the Department of Radiology, NYU Langone Medical Center, New York, NY (G.M.F.)
| | - Mathew Alexander
- From the Departments of Radiology (H.V.M., S.E.M.), Pathology (B.P., G.C.), Neurosurgery (K.P.), and Neurology (M.A.), Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu 632004, India; and the Department of Radiology, NYU Langone Medical Center, New York, NY (G.M.F.)
| | - Girish M. Fatterpekar
- From the Departments of Radiology (H.V.M., S.E.M.), Pathology (B.P., G.C.), Neurosurgery (K.P.), and Neurology (M.A.), Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu 632004, India; and the Department of Radiology, NYU Langone Medical Center, New York, NY (G.M.F.)
| | - Geeta Chacko
- From the Departments of Radiology (H.V.M., S.E.M.), Pathology (B.P., G.C.), Neurosurgery (K.P.), and Neurology (M.A.), Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu 632004, India; and the Department of Radiology, NYU Langone Medical Center, New York, NY (G.M.F.)
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22
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Obusez EC, Jones SE, Mandell D, Bullen J, Gonzalez F, Hui FK. Feasibility of vessel wall imaging in assessing unruptured paraclinoid aneurysms: Clinical observations and preliminary experience. J Clin Neurosci 2019; 61:59-65. [DOI: 10.1016/j.jocn.2018.10.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
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23
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Elnahry AG, Elnahry GA. Computed Tomography Angiography of Bilateral Intracavernous Internal Carotid Artery Aneurysms. Neuroophthalmology 2018; 42:404-405. [PMID: 30524495 DOI: 10.1080/01658107.2018.1433690] [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: 01/16/2018] [Revised: 01/22/2018] [Accepted: 01/24/2018] [Indexed: 10/17/2022] Open
Abstract
Bilateral intracavernous internal carotid artery aneurysms are rare. They are more common in elderly females and are associated with hypertension. We present the computed tomography angiography findings of an 81-year-old female with history of hypertension who came complaining of diplopia and headache. Examination revealed bilateral sixth nerve palsy with left third nerve palsy. External ocular examination was normal. Computed tomography angiography was done and revealed bilateral intracavernous internal carotid artery aneurysms. She was referred to neurosurgery for further management.
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Affiliation(s)
- Ayman G Elnahry
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Gehad A Elnahry
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
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24
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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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25
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Rare and Symptomatic Cavernous Donut-Shaped Aneurysm Treated by Flow Diverter Deployment. World Neurosurg 2018; 121:227-231. [PMID: 30312811 DOI: 10.1016/j.wneu.2018.09.219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND We describe the case of a 62-year-old woman who was admitted to our center for acute diplopia secondary to a left III cranial nerve palsy, left eyelid swelling and ptosis, and mild ipsilateral retroorbital pain. No other motor or sensitive deficits were observed. CASE DESCRIPTION Computed tomography angiography and digital subtraction angiography were performed, showing a 25-mm left intracavernous aneurysm with a central intrasaccular thrombus, an intrasaccular "swirling" flow with a donut-shape appearance. A flow-diverter stent was deployed bridging the aneurysmal neck. CONCLUSIONS Twelve months after the procedure the aneurysm was completely occluded, and the patient had totally recovered the cavernous syndrome. A careful literature review has been performed, and the different endovascular approaches have been analyzed.
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26
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Gagliardi D, Faravelli I, Villa L, Pero G, Cinnante C, Brusa R, Mauri E, Tresoldi L, Magri F, Govoni A, Bresolin N, Comi GP, Corti S. Bilateral Cavernous Carotid Aneurysms: Atypical Presentation of a Rare Cause of Mass Effect. A Case Report and a Review of the Literature. Front Neurol 2018; 9:619. [PMID: 30116219 PMCID: PMC6084507 DOI: 10.3389/fneur.2018.00619] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/10/2018] [Indexed: 11/13/2022] Open
Abstract
Bilateral cavernous carotid aneurysms (CCAs) represent a rare medical condition that can mimic other disorders. We present a rare case of bilateral CCAs simulating an ocular myasthenia. A 76-year-old woman presented with a history of fluctuating bilateral diplopia and unilateral ptosis, which led to the suspicion of ocular myasthenia. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the brain showed the presence of large bilateral aneurysms of the carotid cavernous tract. After an unsuccessful attempt with steroid therapy, the patient underwent endovascular treatment, with mild improvement. Bilateral CCAs can cause pupil sparing third nerve palsies and other cranial neuropathies which can mimic signs and symptoms of disorders of the neuromuscular junction. Therefore, the possibility of a vascular lesion simulating ocular myasthenia should be considered especially in older patients.
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Affiliation(s)
- Delia Gagliardi
- Dino Ferrari Centre, Neuroscience Section, Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Irene Faravelli
- Dino Ferrari Centre, Neuroscience Section, Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luisa Villa
- Neuromuscular Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Dino Ferrari Center, University of Milan, Milan, Italy
| | - Guglielmo Pero
- Department of Neuroradiology, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Claudia Cinnante
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberta Brusa
- Dino Ferrari Centre, Neuroscience Section, Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Eleonora Mauri
- Dino Ferrari Centre, Neuroscience Section, Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Tresoldi
- Ophthalmology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Magri
- Dino Ferrari Centre, Neuroscience Section, Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Govoni
- Dino Ferrari Centre, Neuroscience Section, Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nereo Bresolin
- Dino Ferrari Centre, Neuroscience Section, Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo P Comi
- Dino Ferrari Centre, Neuroscience Section, Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefania Corti
- Dino Ferrari Centre, Neuroscience Section, Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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27
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Durner G, Piano M, Lenga P, Mielke D, Hohaus C, Guhl S, Maldaner N, Burkhardt JK, Pedro MT, Lehmberg J, Rufenacht D, Bijlenga P, Etminan N, Krauss JK, Boccardi E, Hänggi D, Vajkoczy P, Dengler J. Cranial nerve deficits in giant cavernous carotid aneurysms and their relation to aneurysm morphology and location. Acta Neurochir (Wien) 2018; 160:1653-1660. [PMID: 29948299 DOI: 10.1007/s00701-018-3580-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/30/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Giant cavernous carotid aneurysms (GCCAs) usually exert substantial mass effect on adjacent intracavernous cranial nerves. Since predictors of cranial nerve deficits (CNDs) in patients with GCCA are unknown, we designed a study to identify associations between CND and GCCA morphology and the location of mass effect. METHODS This study was based on data from the prospective clinical and imaging databases of the Giant Intracranial Aneurysm Registry. We used magnetic resonance imaging and digital subtraction angiography to examine GCCA volume, presence of partial thrombosis (PT), GCCA origins, and the location of mass effect. We also documented whether CND was present. RESULTS We included 36 GCCA in 34 patients, which had been entered into the registry by eight participating centers between January 2009 and March 2016. The prevalence of CND was 69.4%, with one CND in 41.7% and more than one in 27.5%. The prevalence of PT was 33.3%. The aneurysm origin was most frequently located at the anterior genu (52.8%). The prevalence of CND did not differ between aneurysm origins (p = 0.29). Intracavernous mass effect was lateral in 58.3%, mixed medial/lateral in 27.8%, and purely medial in 13.9%. CND occurred significantly more often in GCCA with lateral (81.0%) or mixed medial/lateral (70.0%) mass effect than in GCCA with medial mass effect (20.0%; p = 0.03). After adjusting our data for the effects of the location of mass effect, we found no association between the prevalence of CND and aneurysm volume (odds ratio (OR) 1.30 (0.98-1.71); p = 0.07), the occurrence of PT (OR 0.64 (0.07-5.73); p = 0.69), or patient age (OR 1.02 (95% CI 0.95-1.09); p = 0.59). CONCLUSIONS Distinguishing between medial versus lateral location of mass effect may be more helpful than measuring aneurysm volumes or examining aneurysm thrombosis in understanding why some patients with GCCA present with CND while others do not. CLINICAL TRIAL REGISTRATION NO NCT02066493 ( clinicaltrials.gov ).
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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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29
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Goyal P, Lee S, Gupta N, Kumar Y, Mangla M, Hooda K, Li S, Mangla R. Orbital apex disorders: Imaging findings and management. Neuroradiol J 2018; 31:104-125. [PMID: 29415610 DOI: 10.1177/1971400917740361] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Orbital apex disorders include orbital apex syndrome, superior orbital fissure syndrome and cavernous sinus syndrome. These disorders result from various etiologies, including trauma, neoplastic, developmental, infectious, inflammatory as well as vascular causes. In the past, these have been described separately based on anatomical locations of disease process; however, these three disorders share similar causes, diagnostic evaluation and management strategies. The etiology is diverse and management is directed to the causative process. This imaging review summarizes the pertinent anatomy of the orbital apex and illustrates representative pathological processes that may affect this region. The purpose of this review is to provide an update on the current status of diagnostic imaging and management of patients with orbital apex disorders.
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Affiliation(s)
- Pradeep Goyal
- 1 21611 St. Vincent's Medical center , Bridgeport, CT, USA
| | | | | | - Yogesh Kumar
- 4 Columbia University at Bassett Healthcare, Cooperstown, NY
| | | | - Kusum Hooda
- 6 Yale New Haven Health at 1939 Bridgeport Hospital , Bridgeport, CT, USA
| | - Shuo Li
- 6 Yale New Haven Health at 1939 Bridgeport Hospital , Bridgeport, CT, USA
| | - Rajiv Mangla
- 7 SUNY Upstate Medical University, Syracuse, NY, USA
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Philipp LR, McCracken DJ, McCracken CE, Halani SH, Lovasik BP, Salehani AA, Boulter JH, Cawley CM, Grossberg JA, Barrow DL, Pradilla G. Comparison Between CTA and Digital Subtraction Angiography in the Diagnosis of Ruptured Aneurysms. Neurosurgery 2018; 80:769-777. [PMID: 28201559 DOI: 10.1093/neuros/nyw113] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 12/08/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Computerized tomography angiography (CTA) is commonly used to diagnose ruptured cerebral aneurysms with sensitivities reported as high as 97% to 100%. Studies validating CTA accuracy in the setting of subarachnoid hemorrhage (SAH) are scarce and limited by small sample sizes. OBJECTIVE To evaluate the diagnostic accuracy of CTA in detecting intracranial aneurysms in the setting of SAH. METHODS A single-center, retrospective cohort of 643 patients was reviewed. A total of 401 patients were identified whose diagnostic workup included both CTA and confirmatory digital subtraction angiography (DSA). Aneurysms missed by CTA but diagnosed by DSA were further stratified by size and location. RESULTS Three hundred and thirty aneurysms were detected by CTA while DSA detected a total of 431 aneurysms. False positive CTA results were seen for 24 aneurysms. DSA identified 125 aneurysms that were missed by CTA and 83.2% of those were <5 mm in diameter. The sensitivity of CTA was 57.6% for aneurysms smaller than 5 mm in size, and 45% for aneurysms originating from the internal carotid artery. The overall sensitivity of CTA in the setting of SAH was 70.7%. CONCLUSION The accuracy of CTA in the diagnosis of ruptured intracranial aneurysm may be lower than previously reported. CTA has a low sensitivity for aneurysms less than 5 mm in size, in locations adjacent to bony structures, and for those arising from small caliber parent vessels. It is our recommendation that CTA should be used with caution when used alone in the diagnosis of ruptured intracranial aneurysms.
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Affiliation(s)
| | - D Jay McCracken
- Department of Neu-rosurgery, Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | | | | | - C Michael Cawley
- Department of Neu-rosurgery, Emory University School of Medicine, Atlanta, Georgia
| | - Jonathan A Grossberg
- Department of Neu-rosurgery, Emory University School of Medicine, Atlanta, Georgia
| | - Daniel L Barrow
- Department of Neu-rosurgery, Emory University School of Medicine, Atlanta, Georgia
| | - Gustavo Pradilla
- Department of Neu-rosurgery, Emory University School of Medicine, Atlanta, Georgia
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Xue Z, Wang F, Sun Z, Zhang H, Wu C, Kong D, Xu B. Intraoperative Computed Tomography (CT) for Treating Giant Carotid Intracavernous Aneurysms. Med Sci Monit 2017. [PMID: 28640793 PMCID: PMC5491137 DOI: 10.12659/msm.902225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Giant carotid intracavernous aneurysm refers to those lesions larger than 2.5 cm and derived from a cavernous segment, accounting for about 30% of all intracranial tumors. Dynamic CT perfusion imaging (PCT) is a common method recently employed to evaluate cerebral perfusion. This study investigated the efficacy and clinical application of intraoperative CT in the surgery for giant symptomatic carotid intracavernous aneurysm. Material/Methods A retrospective analysis was performed on 23 cases with giant symptomatic carotid intracavernous aneurysm. BTO testing was performed before surgery. Differential treatments were performed based on the condition of aneurysm, and some patients received intraoperative PCT. Postoperative anti-coagulation was given with DSA or CTA follow-up examinations at 3–6 months, 1 year, and 2 years after surgery. Results A total of 17 patients received aneurysm isolation coupled with high-flow bypass surgery. Among those, 9 developed early-onset neurological function after surgery, with gradual recover within 6 months. One coma patient died 25 months after discharge. One patient had aneurysm isolation with clapping of anterior communicating artery, and the other 5 cases received artery clapping only. In those patients, 4 had improvement at early phase, while 1 patient had numbness of the oculomotor nerve. Six patients received surgery in the CT room, including 5 cases with single proximal ligation of the internal carotid artery plus 1 aneurysm isolation combined with high-flow bypass surgery. Conclusions Intraoperative PCT can provide objective evidence and effective evaluation of cerebral perfusion.
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Affiliation(s)
- Zhe Xue
- Department of Neurosurgery, General Hospital of PLA, Beijing, China (mainland)
| | - Fuyu Wang
- Department of Neurosurgery, General Hospital of PLA, Beijing, China (mainland)
| | - Zhenghui Sun
- Department of Neurosurgery, General Hospital of PLA, Beijing, China (mainland)
| | - Hui Zhang
- Department of Neurosurgery, General Hospital of PLA, Beijing, China (mainland)
| | - Chen Wu
- Department of Neurosurgery, General Hospital of PLA, Beijing, China (mainland)
| | - Dongsheng Kong
- Department of Neurosurgery, General Hospital of PLA, Beijing, China (mainland)
| | - Bainan Xu
- Department of Neurosurgery, General Hospital of PLA, Beijing, China (mainland)
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Chen C, Hou B, Li WS, Guo Y. Combining Internal Carotid Ligation with Low-Flow Bypass for Treating Large-Giant Cavernous Sinus Segment Aneurysms: A Report of Four Cases. World Neurosurg 2017; 100:280-287. [DOI: 10.1016/j.wneu.2017.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 01/03/2017] [Accepted: 01/04/2017] [Indexed: 11/17/2022]
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Qian Z, Feng X, Kang H, Wen X, Xu W, Li Y, Jiang C, Wu Z, Liu A. Dissecting aneurysms of the distal segment of the posterior cerebral artery: clinical presentation and endovascular management. Chin Neurosurg J 2017. [DOI: 10.1186/s41016-016-0066-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Roy AK, Grossberg JA, Osbun JW, Skukalek SL, Howard BM, Ahmad FU, Tong F, Dion JE, Cawley CM. Carotid cavernous fistula after Pipeline placement: a single-center experience and review of the literature. J Neurointerv Surg 2016; 9:152-158. [DOI: 10.1136/neurintsurg-2016-012586] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/09/2016] [Accepted: 08/16/2016] [Indexed: 11/03/2022]
Abstract
ObjectiveCarotid cavernous fistula (CCF) development after Pipeline Embolization Device (PED) treatment of cavernous carotid aneurysms (CCA) can be a challenging pathology to treat for the neurointerventionalist.MethodsA database of all patients whose aneurysms were treated with the PED since its approval by the Food and Drug Administration in 2011 was retrospectively reviewed. Demographic information, aneurysm characteristics, treatment technique, antiplatelet regimen, and follow-up data were collected. A literature review of all papers that describe PED treatment of CCA was then completed.ResultsA total of 44 patients with 45 CCAs were identified (38 women, 6 men). The mean age was 59.9±9.0 years. The mean maximal aneurysm diameter was 15.9±6.9 mm (mean neck 7.1±3.6 mm). A single PED was deployed in 32 patients, with two PEDs deployed in 10 patients and three PEDs in 3 patients. Adjunctive coiling was performed in 3 patients. Mean follow-up duration based on final imaging (MR angiography or digital subtraction angiography) was 14.1±12.2 months. Five patients (11.4%) developed CCFs in the post-procedural period after PED treatment, all within 2 weeks of device placement. These CCFs were treated with a balloon test occlusion followed by parent artery sacrifice. Our literature review yielded only three reports of CCFs after PED placement, with the largest series having a CCF rate of 2.3%.ConclusionsCCF formation is a known risk of PED treatment of CCA. Although transvenous embolization can be used for treating CCFs, parent artery sacrifice remains a viable option on the basis of these data. Studies support the view that adjunctive coiling may have a protective effect against post-PED CCF formation. None of the coiled aneurysms in our database or in the literature have ruptured. Follow-up data will lead to a better understanding of the safety profile of the PED for CCA.
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Guan N, Mu S, Wang L, Huo X, Jiang Y, Lv X, Li Y. Endovascular Treatment of 147 Cases of Cavernous Carotid Aneurysms: A Single-Center Experience. J Stroke Cerebrovasc Dis 2016; 25:1929-35. [PMID: 27185537 DOI: 10.1016/j.jstrokecerebrovasdis.2016.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 03/09/2016] [Accepted: 04/14/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cavernous carotid aneurysms (CCAs) are characterized by pain and neuro-ophthalmologic deficits. The optimal treatment remains unclear, especially for asymptomatic CCAs. This study investigated the efficacy of endovascular treatment for CCAs in our center. METHODS Data obtained from patients who underwent endovascular treatment for CCAs from July 2011 to July 2014 were reviewed. A retrospective analysis was conducted regarding the general condition, clinical presentation, aneurysm characteristics, therapeutic strategy, and prognosis of CCA patients. RESULTS One hundred forty-seven patients who exhibited 155 CCAs were included, which comprised 46 asymptomatic and 101 symptomatic CCA cases. Forty-eight cases presented with headache, 5 cases presented with subarachnoid hemorrhage, 20 cases presented with diplopia, 38 cases presented with cranial nerve palsy, and 27 cases presented with ischemic stroke. The mean aneurysm sizes were 15.3 ± 12.2 and 8.1 ± 7.1 mm in the symptomatic and asymptomatic groups, respectively. Different treatments were administered: coil occlusion (n = 15), stent/balloon-assisted coil occlusion (n = 123), and parent artery occlusion (PAO) (n = 17). The PAO-treated group exhibited the highest aneurysm occlusion rate. Follow-up data were available for 131 cases, which included 86 symptomatic and 45 asymptomatic cases. There were no deaths. Among the symptomatic patients, 40.7% improved, 58.1% remained stable, and 1.2% worsened; 12 patients exhibited regrowth and 6 patients had repeated endovascular treatment. The asymptomatic patients remained stable, including 5 patients who exhibited regrowth and 2 patients who had repeated endovascular treatment. CONCLUSION Endovascular treatment is safe and effective for CCAs and should be considered in patients with minimal complications, as well as in asymptomatic patients with stable symptoms.
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Affiliation(s)
- Ning Guan
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shiqing Mu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Linyuan Wang
- Department of Periodontics, The Second Affiliated Hospital of Liaoning Medical College, Jinzhou, Liaoning, China
| | - Xiaochuan Huo
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuhua Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xianli Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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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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Warburton RE, Brookes CCD, Golden BA, Turvey TA. Orbital apex disorders: a case series. Int J Oral Maxillofac Surg 2015; 45:497-506. [PMID: 26725107 DOI: 10.1016/j.ijom.2015.10.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 08/05/2015] [Accepted: 10/16/2015] [Indexed: 12/27/2022]
Abstract
Orbital apex syndrome is an uncommon disorder characterized by ophthalmoplegia, proptosis, ptosis, hypoesthesia of the forehead, and vision loss. It may be classified as part of a group of orbital apex disorders that includes superior orbital fissure syndrome and cavernous sinus syndrome. Superior orbital fissure syndrome presents similarly to orbital apex syndrome without optic nerve impairment. Cavernous sinus syndrome includes hypoesthesia of the cheek and lower eyelid in addition to the signs seen in orbital apex syndrome. While historically described separately, these three disorders share similar causes, diagnostic course, and management strategies. The purpose of this study was to report three cases of orbital apex disorders treated recently and to review the literature related to these conditions. Inflammatory and vascular disorders, neoplasm, infection, and trauma are potential causes of orbital apex disorders. Management is directed at the causative process. The cases described represent a rare but important group of conditions seen by the maxillofacial surgeon. A review of the clinical presentation, etiology, and management of these conditions may prompt timely recognition and treatment.
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Affiliation(s)
- R E Warburton
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - C C D Brookes
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - B A Golden
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - T A Turvey
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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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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Su IC, Cruz JP, Krings T. Low-flow direct carotid-cavernous fistula caused by rupture of an intracavernous carotid aneurysm. Interv Neuroradiol 2014; 20:476-81. [PMID: 25207911 DOI: 10.15274/inr-2014-10057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 01/26/2014] [Indexed: 11/12/2022] Open
Abstract
Direct carotid-cavernous fistulas (CCFs) secondary to a ruptured intracavernous carotid aneurysm (ICCA) are usually high-flow lesions. On very rare occasions, a ruptured ICCA may present as a low-flow CCF, which poses a diagnostic and therapeutic dilemma whether the aneurysm and the observed fistula are causally related. Herein, we describe a rare case in which a ruptured ICCA resulted in a low-flow CCF. We demonstrated our approach to clarify this clinical scenario, and also propose a possible pathomechanism to explain the existence of low-flow direct CCF.
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Affiliation(s)
- I-Chang Su
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network; Toronto, Ontario, Canada - Division of Neurosurgery, Department of Surgery, Taipei Cathay General Hospital; Taipei, Taiwan -
| | - Juan Pablo Cruz
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network; Toronto, Ontario, Canada
| | - Timo Krings
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network; Toronto, Ontario, Canada - Division of Neurosurgery, Toronto Western Hospital, University of Toronto; Ontario, Canada
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Tanweer O, Raz E, Brunswick A, Zumofen D, Shapiro M, Riina HA, Fouladvand M, Becske T, Nelson PK. Cavernous carotid aneurysms in the era of flow diversion: a need to revisit treatment paradigms. AJNR Am J Neuroradiol 2014; 35:2334-40. [PMID: 25147199 DOI: 10.3174/ajnr.a4081] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Recent techniques of endoluminal reconstruction with flow-diverting stents have not been incorporated into treatment algorithms for cavernous carotid aneurysms. This study examines the authors' institutional experience and a systematic review of the literature for outcomes and complications using the Pipeline Embolization Device in unruptured cavernous carotid aneurysms. MATERIALS AND METHODS A retrospective search for cavernous carotid aneurysms from a prospectively collected data base of aneurysms treated with the Pipeline Embolization Device at our institution was performed. Baseline demographic, clinical, and laboratory values; intrainterventional data; and data at all follow-up visits were collected. A systematic review of the literature for complication data was performed with inquiries sent when clarification of data was needed. RESULTS Forty-three cavernous carotid aneurysms were included in the study. Our mean radiographic follow-up was 2.05 years. On last follow-up, 88.4% of the aneurysms treated had complete or near-complete occlusion. Aneurysm complete or near-complete occlusion rates at 6 months, 12 months, and 36 months were 81.4%, 89.7%, and 100%, respectively. Of patients with neuro-ophthalmologic deficits on presentation, 84.2% had improvement in their visual symptoms. Overall, we had a 0% mortality rate and a 2.3% major neurologic complication rate. Our systematic review of the literature yielded 227 cavernous carotid aneurysms treated with the Pipeline Embolization Device with mortality and morbidity rates of 0.4% and 3.1%, respectively. CONCLUSIONS Endoluminal reconstruction with flow diversion for large unruptured cavernous carotid aneurysms can yield high efficacy with low complications. Further long-term data will be helpful in assessing the durability of the cure; however, we advocate a revisiting of current management paradigms for cavernous carotid aneurysms.
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Affiliation(s)
- O Tanweer
- From the Departments of Neurosurgery (O.T., A.B., D.Z., P.K.N.)
| | - E Raz
- Radiology (E.R., D.Z., M.S., H.A.R., T.B., P.K.N.)
| | - A Brunswick
- From the Departments of Neurosurgery (O.T., A.B., D.Z., P.K.N.)
| | - D Zumofen
- From the Departments of Neurosurgery (O.T., A.B., D.Z., P.K.N.) Radiology (E.R., D.Z., M.S., H.A.R., T.B., P.K.N.)
| | - M Shapiro
- Radiology (E.R., D.Z., M.S., H.A.R., T.B., P.K.N.)
| | - H A Riina
- Radiology (E.R., D.Z., M.S., H.A.R., T.B., P.K.N.)
| | - M Fouladvand
- Neurology (M.F., T.B., P.K.N.), New York University School of Medicine, New York, New York
| | - T Becske
- Radiology (E.R., D.Z., M.S., H.A.R., T.B., P.K.N.) Neurology (M.F., T.B., P.K.N.), New York University School of Medicine, New York, New York
| | - P K Nelson
- From the Departments of Neurosurgery (O.T., A.B., D.Z., P.K.N.) Radiology (E.R., D.Z., M.S., H.A.R., T.B., P.K.N.) Neurology (M.F., T.B., P.K.N.), New York University School of Medicine, New York, New York.
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Cavernous carotid artery aneurysms: epidemiology, natural history, diagnostic and treatment. An experience of a single institution. Clin Neurol Neurosurg 2014; 125:32-5. [PMID: 25083803 DOI: 10.1016/j.clineuro.2014.07.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 06/12/2014] [Accepted: 07/13/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cavernous carotid aneurysms (CCA) account for 2-9% of all intracranial aneurysms. They have been considered benign lesions, most often asymptomatic, and to have a natural history with a low risk of life-threatening complications. These aneurysms are unique, their rupture can present in many different forms, they can suffer spontaneous thrombotic changes and the symptomatology related to the mass effect involves the neuro-ophthalmologic system. In this scenario the natural history and clinical presentation are largely different from other intracranial aneurysms. Some investigators advocate treatment of both symptomatic and asymptomatic CCAs, others recommend no treatment. The reason for this controversy relates to a lack of information on the long term natural history of these aneurysms, as well as on the long term results of treatment. METHODS In this article the authors discuss their single institution experience in diagnosis, natural history and management of 123 asymptomatic and oligosympotomatic aneurysms located in the cavernous portion of internal carotid artery. CONCLUSIONS According to our results asymptomatic or olygosymptomatic (pain) CCAs should be conservatively managed with serial images while the others presentations should be analyzed by a multidisciplinary team, involving the neuroendovascular and microsurgical services.
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Chapman PR, Gaddamanugu S, Bag AK, Roth NT, Vattoth S. Vascular lesions of the central skull base region. Semin Ultrasound CT MR 2014; 34:459-75. [PMID: 24216454 DOI: 10.1053/j.sult.2013.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The arterial and venous structures of the central skull base region form complex anatomical relationships with each other and with adjacent osseous and neural structures. Vascular structures including the cavernous sinuses and internal carotid arteries can be displaced, encased, or invaded by neoplastic, inflammatory, or infectious lesions of the central skull base. Consequently, the vascular structures have a unique role in determining the imaging appearance, clinical significance, and therapeutic options of lesions occurring in the central skull base. This article briefly reviews the basic anatomy of the cavernous sinus and the relationship of the internal carotid artery to the cavernous sinus and central skull base. The major imaging features of some common vascular lesions, including skull base aneurysm, carotid-cavernous fistula, and cavernous sinus thrombosis are presented.
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Affiliation(s)
- Philip R Chapman
- Department of Radiology, Section of Neuroradiology, University of Alabama at Birmingham, Birmingham, AL.
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Penchet G, Mourier K. Collaborative retrospective multicentre series of giant intracavernous carotid aneurysms. Neurochirurgie 2014; 61:366-70. [PMID: 24661583 DOI: 10.1016/j.neuchi.2013.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 12/03/2013] [Accepted: 12/23/2013] [Indexed: 11/19/2022]
Abstract
Giant intracavernous carotid aneurysms (GICCA) occur with very unusual clinical symptoms often resulting from a compressive mechanism that may possibly resolve although seldom from a rupture or haemorrhage. In fact, due to their clinical presentation their treatment is different from that of the intracranial subarachnoid aneurysms. The aim of this study was to analyze the clinical symptoms, therapeutic decisions, and the clinical state at 6 months follow up in a retrospective consecutive multicentre series of 27 GICCA between 2004 and 2008. All the patients in the series were female, mean age 65 years (21 to 82 years). A pseudo tumoural cavernous sinus syndrome revealed the disease in 25 patients (92.6%), an atypical headache in one patient, and in another patient an intraoperative haemorrhage led to the diagnosis. In most of the cases the aneurysms were sacciform in shape (89%), with a size between 25 and 30 millimeters (66.6%) and contained a blood clot due to intrasacular thrombosis (57.5%). An occlusion test of the internal carotid artery was performed during the diagnostic angiography in 24 cases (88.8%) and good tolerance of occlusion was observed in 16 of them. An endovascular procedure was performed in 21 patients (77.7%): selective coiling of the aneurysm facilitated by stenting or by remodeling techniques in 2 cases, whereas internal carotid artery occlusion was performed on the 19 other cases. Among these latter patients, 2 of them (10.5%) presented with a poor tolerance during the pre-therapeutic carotid occlusion test, necessitating a surgical intra-extra cranial by-pass prior to the carotid endovascular occlusion. In 1 other case of these 19, the internal carotid endovascular occlusion was carried-out in emergency because the aneurysm was revealed by a major haemorrhage during the surgical transsphenoidal approach of a hypophyseal tumour. No treatment was decided in the remaining 6 cases of the series (22.2%). At 6 months follow-up, 18 of the 21 treated patients experienced a clinical recovery of their symptoms and 10 of them (50%) had a complete clinical recovery. Among the 6 untreated patients, 4 had a partial recovery but no complete recovery of oculomotor deficits was observed in this group of patients. No clinical worsening was observed in the entire series, neither among the treated patients nor among the untreated patients. In conclusion, this study underlines the need of a treatment for symptomatic GICCA in order to achieve a complete clinical recovery of the symptoms due to intracavernous compression, although only partial recovery may be expected from spontaneous evolution.
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Affiliation(s)
- G Penchet
- Department of Neurosurgery, Pellegrin Tripode Hospital, Bordeaux University Hospital, Bordeaux, France.
| | - K Mourier
- Department of Neurosurgery, Bocage Central Hospital, Dijon University Hospital, Dijon, France.
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Can CT angiography rule out aneurysmal subarachnoid haemorrhage in CT scan-negative subarachnoid haemorrhage patients? J Clin Neurosci 2014; 21:191-3. [DOI: 10.1016/j.jocn.2013.03.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 02/24/2013] [Accepted: 03/09/2013] [Indexed: 12/29/2022]
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45
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Sastri SB, Sadasiva N, Pandey P. Giant cavernous carotid aneurysm with spontaneous ipsilateral ICA occlusion: Report of 2 cases and review of literature. J Neurosci Rural Pract 2013; 4:S113-6. [PMID: 24174776 PMCID: PMC3808038 DOI: 10.4103/0976-3147.116439] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Giant aneurysms of the cavernous carotid artery are rare entities which present predominantly with features of compression of the adjacent neural structures, most commonly the III, IV, VI and V cranial nerves. Historically, treatment options included occlusion of the feeding vessel, direct surgery on the aneurysm, bypass procedures and in recent times, the use of endovascular devices. While intramural thrombus formation is commonly seen in giant aneurysms, we present 2 cases of giant cavernous aneurysms which on evaluation were found to have spontaneous occlusion of the feeding internal carotid artery secondary to thrombus formation, and review the available literature regarding the same.
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Chalouhi N, Dumont AS, Hasan D, Tjoumakaris S, Gonzalez LF, Starke RM, Dalyai R, El Moursi S, Rosenwasser R, Jabbour P. Is packing density important in stent-assisted coiling? Neurosurgery 2013; 71:381-6; discussion 386-7. [PMID: 22569059 DOI: 10.1227/neu.0b013e31825c36dd] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Recent reports have shown that stent-assisted coiling (SAC) is associated with lower aneurysm recanalization rates compared with conventional coiling, raising questions about the necessity of achieving high packing density (PD) in stented aneurysms. OBJECTIVE To assess the impact of PD on follow-up obliteration rates of stented aneurysms and attempt to determine the optimal range of PD in SAC. METHODS This is a retrospective analysis of a single, large, cerebrovascular referral center's experience over a 5-year period in SAC with the use of Neuroform and Enterprise stents. The rate of complete obliteration on follow-up angiograms was compared for 3 different PD groups: high PD (>22%), moderate PD (12-22%), and low PD (<12%). RESULTS There were 292 stent-coiled aneurysms (36 ruptured, 256 unruptured) with available angiographic follow-up. Mean PD was 15.2%, and complete obliteration rate was 79.5% at latest follow-up. The rates of complete obliteration were significantly higher in the moderate (86.4%; OR = 2.58; P = .006) and high PD groups (85.3%; OR = 2.35; P = .037) compared with the low PD group (71.1%). However, no statistically significant difference was found between the moderate and high PD groups (OR = 0.91; P = .84). In multivariate analysis, PD was a significant predictor of complete obliteration (P = .007) along with smaller aneurysm volumes (P = .004). Ruptured (P = .002) and cavernous aneurysms (P < .001) had significantly lower obliteration rates. CONCLUSION High obliteration rates at follow-up were observed despite modest packing of stented aneurysms. Although PD is a definite factor in SAC, moderate and high packing of stented aneurysms seems to provide equivalent angiographic obliteration rates at follow-up.
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Affiliation(s)
- Nohra Chalouhi
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Aaron S. Dumont
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - David Hasan
- Department of Neurosurgery, University of Iowa, Iowa City, Iowa
| | - Stavropoula Tjoumakaris
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - L. Fernando Gonzalez
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Robert M. Starke
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Richard Dalyai
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Sedeek El Moursi
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Robert Rosenwasser
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
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47
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Chan HW, Haliasos N, Derakhshani S, Vindlacheruvu R, Chawda S. Delayed caroticocavernous fistula after stent-assisted coil embolization of intracavernous carotid aneurysm: should we manage conservatively? Acta Neurochir (Wien) 2011; 153:1291-5. [PMID: 21347579 DOI: 10.1007/s00701-011-0968-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 02/07/2011] [Indexed: 11/24/2022]
Abstract
Constructive endovascular techniques remain the mainstay for the treatment of cavernous carotid aneurysms due to their efficacy. However, they do harbor risks of complications, such as thromboembolic events, arterial injuries, and vessel occlusions. A 58-year-old lady presented with delayed caroticocavernous fistula (CCF) 1 month after stent-assisted coil embolization of a cavernous carotid aneurysm (CCA). Following this, her caroticocavernous fistula resolved spontaneously with no further intervention. Our case demonstrates a unique presentation of a CCF as a delayed complication of stent-assisted coil embolization of CCA and the spontaneous resolution of the CCF. Symptomatic CCFs are commonly treated as an emergency in many institutions and the question arises as to whether we should adopt a conservative policy in the light of this case report.
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Affiliation(s)
- Huan Wee Chan
- Queens Hospital, Rom Valley Way, Romford, RM7 0AG, UK.
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48
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Aydin K, Bakan S, Pekcan M, Yahyayev A. Giant intracavernous carotid aneurysm with intraorbital extension: an unusual cause of unilateral proptosis. Acta Neurochir (Wien) 2011; 153:1149-50. [PMID: 21234616 DOI: 10.1007/s00701-010-0930-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 12/22/2010] [Indexed: 11/30/2022]
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49
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De Blasi R, Bracciolini E, Chiumarulo L, Salvati A, Monetti C, Federico F, Carella A. Pseudoaneurysm formation following intrasphenoid rupture of an idiopathic intracavernous carotid artery aneurysm: coil migration and early recurrence after endovascular treatment. Interv Neuroradiol 2010; 16:442-6. [PMID: 21162775 DOI: 10.1177/159101991001600411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Accepted: 09/04/2010] [Indexed: 11/15/2022] Open
Abstract
Intrasphenoid rupture of a non-traumatic aneurysm of the cavernous carotid artery is rare. We describe a patient in whom this condition manifested with epistaxis and led to the formation of a pseudoaneurysm occupying the right sphenoid sinus. The lesion recurred after repeated attempts at conservative endovascular therapy. Eventually the patient was treated with endovascular occlusion of the right internal carotid artery. Our report emphasizes the relapsing behaviour of a non-traumatic aneurysm of the cavernous portion of the internal carotid artery ruptured into the sphenoid sinus.
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Affiliation(s)
- R De Blasi
- Unit of Neuroradiology and Interventional Radiology, "Di Venere" Hospital, Bari, Italy
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