Various Treatments for Internal Carotid Artery-cavernous Aneurysms : Therapeutic Indications and Modalities

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  • Taki Waro
    Department of Neurosurgery, Faculty of Medicine, Kyoto University
  • Tanaka Masato
    Department of Neurosurgery, Faculty of Medicine, Kyoto University
  • Nagata Izumi
    Department of Neurosurgery, Faculty of Medicine, Kyoto University
  • Nakahara Ichiro
    Department of Neurosurgery, Faculty of Medicine, Kyoto University
  • Kikuchi Haruhiko
    Department of Neurosurgery, Faculty of Medicine, Kyoto University

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  • 内頸動脈海綿静脈洞部動脈瘤の治療 : 治療適応と治療方針(<特集>海綿静脈洞病変をどう治療するか)

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Thirty-three patients with internal carotid artery-cavernous aneurysms (ICA-cav. AN.) were included in this study. ICA-cav. AN. were defined as aneurysms located proximal to the ophthalmic artery. The ICAs Were divided into three groups based on Fischer,s classification, such as C3, C4, and C5, and the aneurysms were classified into three groups by size : small (less than 14 mm), large (15-24 mm) , giant (more than 25 mm). The patients were 6 males and 27 females aged 14 to 74 years. Initial symptoms were mass sign in 23 cases, epistaxis in 2, SAH (subarachnoid hemorrhage) in 1 and incidental occasion in 7. ICA balloon occlusion tests (BOTs) were performed under normotension in 17 cases and under hypotension with CBF (cerebral blood flow) study in 8, prior to various treatments. The results of neurological examinations were negative in all cases, but CBF in the affected hemisphere after temporary ICA occlusion was reduced in the 6 cases of the hypotension challenge group. Twenty-six of the patients were treated using various methods. C3 small aneurysms were surgically clipped, large or giant aneurysm underwent intentional ICA occlusion. However recently large and giant aneurysms have been treated by endosaccular embolization using microcoils to preserve the parent artery. Perioperative complications included cerebral infarctions in case of large and giant C3 aneu-rysms treated by surgical trapping of the ICA after failed clipping and transient ischemic attacks (TIAs) in 3 of 18 cases in which intentional ICA occlusion was performed. In conclusion, surgical clipping or endosaccular embolization is the treatment of first choice in cases of C3 aneurysms and intentional ICA occlusion after BOT is the treatment of second choice in cases of large and giant aneurysms. In cases of C4, 5 aneurysms endosaccular coil embolization and intentional ICA occlusion after BOT are the treatments of first and second choice, respectively.

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