Problems in the Management of Unruptured Intracavernous Aneurysms of the Internal Carotid Artery

Ohnishi Hideyuki, Karasawa Jun, Touho Hajime, Furuoka Norihiko, Monobe Tatsuhiko

doi:10.7887/jcns.4.333

This paper discusses aneurysms of the cavernous portion of the internal carotid artery, specifically 49 asymptomatic (44 patients) and 12 symptomatic (12 patients) unruptured aneurysm of the cavernous portion of the internal carotid artery that were surgically treated. All asymptomatic aneurysms were operated on directly (neck clipping : 48 aneurysms, trapping : 1 aneurysm) . The assigned grading of the Glasgow Outcome Scale was I for 43 patients and II for 1 patient. Major complications encountered were oculomotor nerve palsies and visual disturbances. Further, oculomotor nerve palsies appeared postoperatively in 19 patients but all were transient. Also, visual disturbances appeared in 5 patients. All symptomatic aneurysms were giant aneurysms and were treated directly in 8 patients and by an internal carotid ligation plus an EC-IC (extracranial-intracranial) vein graft in 4 patients. Preoperative oculomotor nerve palsies and symptoms of trigeminal neuralgia all disappeared after the surgery. Recovery from abducens nerve palsy that had affected 8 patients was complete in 5 patients, partial in 2 patients and worsened in I patient. Based on the surgical findings, these aneurysms of the cavernous portion of the internal carotid artery (infraclinoid aneurysms) can be classified by site into 3 groups, I, II, and III. Group I aneurysms are located distal to the distal dural ring and project ventromedially. Group I A aneurysms are distal to the origin of ophthalmic artery, and Group I B aneurysms are proximal to the artery. These Group I aneurysms originate below the level of the anterior clinoid process and are subdural aneurysms. Group II aneurysms originate between the distal ring and the proximal ring. Group II aneurysms are pericavernous sinus aneurysms that sometimes grow into the subdural space beyond the distal ring. Group III aneurysms are located proximal to the proximal ring and are genuine intracavernous aneurysms. These classifications are extremely useful when selecting the aneurysms amenable to surgery and the surgical procedures to be used.

Problems in the Management of Unruptured Intracavernous Aneurysms of the Internal Carotid Artery

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