Summary
We have studied the results of carotid occlusion in the treatment of giant intracavernous carotid artery (ICA) aneurysms in 40 patients. Clinical, angiographic, Doppler and cerebral blood flow (CBF) criteria for tolerance of occlusion are discussed. The patients had headaches (47.5%), cranial nerve compression (87.5%), decreased visual acuity (20%), ruptured aneurysm (15%) and 5% were asymptomatic. Balloon occlusion tests were performed under light sedation anaesthesia: a successful test required perfect clinical tolerance and adequate angiographic collateral circulation in arterial, parenchymatous, and venous phases. Additional criteria include xenon 133 CBF measurements, and transcranial Doppler sonography of the middle cerebral artery. According to these criteria, 5 patients did not tolerate test occlusion and required an extra-intracranial (EC-IC) bypass. Mean follow-up was 4.7 years. All patients were radiologically cured of their ancurysm, and in 35 the symptoms resolved, although 3 had persistent ocular motor nerve palsies, and in 4 visual defects were unchanged. Complications were 1 permanent and 3 transient neurological deficits. Balloon occlusion of the ICA is an effective, reliable form of treatment for intracavernous giant aneurysm and should replace surgical ligation of the cervical carotid artery. With CBF or Doppler monitoring, the risk of neurological deficit is diminished. EC-IC bypass prior to ICA occlusion is indicated if test occlusion is not tolerated.
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References
Morley TP, Barr HWK (1968) Giant intracranial aneurysms, diagnosis, course and management. Clin Neurosurg 15:73–94
Meadows SP (1959) Intracavernous aneurysms of the internal carotid artery, their clinical features and natural history. Arch Ophthalmol 62:566–574
Linskey ME, Sekhar LN, Hirsch W, Yonas H, Horton JA (1990) Aneurysms of the intracavernous carotid artery: clinical presentation, radiographic features, and pathogensis. Neurosurgery 26:71–79
Kupersmith MJ, Berenstein A, Choi IS, et al (1984) Percutaneous transvascular treatment of giant carotid aneurysms: neuroophthalmologic findings. Neurology 34:328–335
Hodes JE, Fletcher WA, Goodmann DF, Hoyt WF (1988) Rupture of cavernous carotid artery aneurysm causing subdural hematoma and death. Case report. J Neurosurg 69:617–619
Sindou M, Keravel Y (1984) Les anévrysmes géants intracraniens. Approches thérapeutiques. Neurochirurgie 30 [Suppl 1]
Drake CG (1979) Giant intracranial aneurysms: experience with surgical treatment in 174 patients. Clin Neurosurg 26:12–95
Diaz FG, Ohaegbulam S, Dujovny M, Ausman JI (1988) Surgical management of aneurysms in the cavernous sinus. Acta Neurochir (Wien) 91:25–28
Swearingen B, Heros RC (1987) Common carotid occlusion of unclippable carotid aneurysms: an old but still effective operation. Neurosurgery 21:288–294
Gelber BR, Sundt TM Jr (1980) Treatment of intracavernous and giant carotid aneurysms by combined internal carotid ligation and extra- to intracranial bypass. J Neurosurg 52:1–10
Spetzler RF, Schuster H, Roski RA (1980) Elective extracranial-intracranial arterial bypass in the treatment of inoperable giant aneurysms of the internal carotid artery. J Neurosurg 53:22–27
Yonekawa Y, Yasargil MG (1976) Extra-intracranial arterial anastomosis: clinical and technical aspects. Results. Adv Tech Stand Neurosurg 3:47–76
Al Mefty O, et al (1987) Supraorbital-pterional approach to skull base lesions. Neurosurgery 21:474–477
Dolenc V (1983) Direct microsurgical repair of intracavernous vascular lesions. J Neurosurg 58:824–831
Patterson RH, Ray BS (1962) Profound hypothermia for intracranial surgery, laboratory and clinical experience with extracorporal circulation by peripheral cannulation. Ann Surg 156:377–393
Serbinenko FA (1974) Balloon catheterization and occlusion of major cerebral vessels. J Neurosurg 41:125–145
Debrun G, Fox A, Drake CG, Peerless S, Girvin J, Ferguson G (1981) Giant unclippable aneurysms: treatment with detachable balloons. AJNR 2:167–173
Fox AJ, Viñuela F, Pelz DM, et al (1987) Use of detachable balloons for proximal artery occlusion in the treatment of unclippable cerebral aneurysms. J Neurosurg 66:40–46
Higashida RT, Halbach VV, Dowd C, Barnwell SL, Dormandy W, Bell J, Hieshima GB (1990) Endovascular detachable balloon embolization therapy of cavernous carotid artery aneurysms: results in 87 cases. J Neurosurg 72:857–863
Linskey ME, Sekhar LN, Hirsch W, Yonas H, Horton JA (1990) Aneurysms of the intracavernous carotid artery: natural history and indications for treatment. Neurosurgery 26:933–938
Scott B, Skwarok E (1961) The treatment of cerebral aneurysms by ligation of the common carotid artery. Surg Gynecol Obstet 113:54–61
Nishioka H (1966) Report on the Cooperative Study of intracranial aneurysms and subarachnoid hemorrhage. Section VIII, Part 1. Results of the treatment of intracranial aneurysms by occlusion of the carotid artery in the neck. J Neurosurg 25:660–682
Kak VK, Taylor AR, Gordon DS (1973) Proximal carotid ligation for internal carotid aneurysms. A long term follow-up study. J Neurosurg 39:503–513
Roski RA, Spetzler RF, Nulsen FE (1984) Late complications of carotid ligation in the treatment of intracranial aneurysms. J Neurosurg 54:583–587
Diaz FG, Ausman JI, Pearce JG (1982) Ischemic complications after internal carotid artery occlusion and extracranial intracranial anastomosis. Neurosurgery 10:563–570
Heros RC (1984) Thromboembolic complications after combined internal carotid ligation and extracranial to intracranial bypass. Surg Neurol 21:75–79
Hilal SK, Khandji AG, Solomon RW (1984) Obliteration of intracranial aneurysms with preshaped highly thrombogenic coils. Radiology, 173:250
Romodanov AP, Shcheglov VI (1982) Intravascular occlusion of saccular aneurysms of the cerebral arteries by means of a detachable balloon catheter. Adv Tech Stand Neurosurg 9:25–49
Higashida RT, Halbach W, Barnwell SL, Dowd D, Dormandy B, Bell J (1990) Treatment of intracranial aneurysms with preservation of the parent vessel: results of percutaneous balloon embolization in 84 patients. AJNR 11:633–640
Berenstein A, Ransohoff J, Kupersmith M, Flamm E, Graeb D (1984) Transvascular treatment of giant aneurysms of the cavernous carotid and vertebral arteries. Surg Neurol 21:3–12
Serbinenko FA, Filatov JM, Spallone A, Tchurilov V, Lazarev A (1990) Management of giant intracranial ICA aneurysms with combined extracranial intracranial anastomosis and endovascular occlusion. J Neurosurg 37:57–63
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Añon, V.V., Aymard, A., Gobin, Y.P. et al. Balloon occlusion of the internal carotid artery in 40 cases of giant intracavernous aneurysm: technical aspects, cerebral monitoring, and results. Neuroradiology 34, 245–251 (1992). https://doi.org/10.1007/BF00596347
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DOI: https://doi.org/10.1007/BF00596347