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The carotid-cavernous aneurysm is a direct communication between the internal carotid artery (i. c. a.) and the cavernous sinus. A rupture of the artery is alone enough to cause a fistula. Such a pathologic communication is usually serious but surgical treatment sometimes gives very favourable results. These depend upon accuracy in diagnosis, a thorough knowledge of the extent of the lesion, its anatomical relationships and of the conditions in the cerebral circulation. Arteriography -more than the clinical examination -gives such information, Treatment consists in the mechanical interruption of the afflux of blood t o the aneurysm and thus its thrombosis. Clinical pictureThe carotid-cavernous aneurysm is either traumatic or spontaneous, the latter being less frequent. The ratio of the frequency between the traumatic and spontaneous aneurysm is about three to one (DANDY 5). The traumatic aneurysm occurs more often in men, while the spontaneous aneurysm is more common in women.Trauma may consist of a cranial fracture, often involving the base of the middle cranial fossa, or a penetrating wound through the orbit, the nose or the mouth. Sometimes the degree of trauma is very slight: a blow on the skull without even concussion of the brain.A spontaneous aneurysm usually occurs in hypertensive and arteriosclerotic subjects or as a result of a sudden increase of blood pressure due to physical effort, pregnancy, etc. A saccular subclinoidal arterial aneurysm may rupture into the cavernous sinus causing a fistula. According to CHARCOT the intracavernous tract of the carotid artery is less resistant than all other portions of this vessel. 122 GIOVASNI RUQGIERO AXD FRANCEBCO CASTELLANOThe main sign is a unilateral pulsating exophthalmos accompanied by the subjec tive sensation of an intracranial thrill and bruit synchronous with tjhe pulse.In the spontaneous cases the onset of the condition is sudden and often accompanied by an attack of headache, indisposition and vomiting, immediately followed by a sensation of the thrill. Exophthalmos, on the contrary, is not always an initial sign. I n the majority of the traumatic cases exophthalmos has its onset from one week to several months after the injury. The exophthalmos develops very rapidly and becomes unchanged or increases very slowly; it is sometimes bilateral (17 yo SATTLER, 11.5 "/b DE SCHWEINITZ). I n some instances there is contralateral exophthalinos only. This may be due either t o abnormalities of the venous system or to unusual conditions created by the trauma, i. e. crushmg of the ophthalmic veins on the side of the fistula as a result of fracture of the sphenoid bone (SATTLER); the arterial blood thus flows through the intercavernous sinuses into the opposite cavernous sinus and then into the ophthalmic veins. The exophthalmos may in rare instances disappear as a result of spontaneous thrombosis. DANDY reports a case in which bilateral exophthalnios was primarily present but in which later on only unilateral exophthalmos was observed. He localized the aneurysm...

The carotid-cavernous aneurysm is a direct communication between the internal carotid artery (i. c. a.) and the cavernous sinus. A rupture of the artery is alone enough to cause a fistula. Such a pathologic communica tion is usually serious but surgical treatment sometimes gives very favourable results. These depend upon accuracy in diagnosis, a thorough knowledge of the extent of the lesion, its anatomical relationships and of the conditions in the cerebral circulation. Arteriography -more than the clinical examination -gives such information. Treatment consists in the mechanical interruption of the afflux of blood to the aneurysm and thus its thrombosis. Clinical pictureThe carotid-cavernous aneurysm is either traumatic or spontaneous, the latter being less frequent. The ratio of the frequency between the traumatic and spontaneous aneurysm is about three to one (DANDY 5). The traumatic aneurysm occurs more often in men, while the spontaneous aneurysm is more common in women.Trauma may consist of a cranial fracture, often involving the base of the middle cranial fossa, or a penetrating wound through the orbit, the nose or the mouth. Sometimes the degree of trauma is very slight: a blow on the skull without even concussion of the brain.A spontaneous aneurysm usually occurs in hypertensive and arteriosclerotic subjects or as a result of a sudden increase of blood pressure due to physical effort, pregnancy, etc. A saccular subclinoidal arterial aneu rysm may rupture into the cavernous sinus causing a fistula. According to CHARCOT the intracavernous tract of the carotid artery is less resistant than all other portions of this vessel.

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