Aneurysms of the Intracavernous Carotid Artery: Clinical Presentation, Radiographic Features, and Pathogenesis

Abstract

Thirty-seven patients with 44 intracavernous carotid artery aneurysms (ICCAAns) were seen at one institution from 1976 through 1988. Fifteen patients had multiple intracranial aneurysms and 7 had bilateral ICCAAns. Age at diagnosis ranged from 15 to 80 (median 61). Thirty patients were women. Sixteen had a history of hypertension. In 34% of patients the ICCAAns were asymptomatic at diagnosis. 36% were associated with headache, and 57% had associated signs or symptoms of mass effect including sixth nerve paresis (43%). trigeminal pain or sensory loss (32%), third nerve paresis (20%), decreased vision or visual field cut (18%), fourth nerve paresis (16%), and Horner's syndrome (7%). In 4 patients the ICCAAns ruptured, leading to subarachnoid hemorrhage in 3 and epistaxis in 1. Two patients with ICCAAns were seen with spontaneous thrombosis of the ipsilateral internal carotid artery leading to distal ischemic symptoms in 1. More than 90% of the ICCAAns were saccular. Thirty-four percent were small (<1 cm), 48% were large (1 to 2.5 cm), and 16% were giant (>2.5 cm). The majority arose from the anterior genu of the intracavernous internal carotid artery, followed in frequency by the horizontal segment, and then the posterior genu. Magnetic resonance imaging is superior to computed tomography for diagnosing ICCAAns and is the screening procedure of choice. Angiography remains the “gold standard” for diagnosis and determining specific anatomic details necessary to plan therapy. Analyzing the radiographic anatomy of 44 ICCAAns, we conclude that theories attributing the origin of aneurysms to arterial bifurcations may be inadequate to explain the point of origin and direction of take off of up to one-fourth of ICCAAns. (Neurosurgery 26:71-79, 1990)

Aneurisma gigante do segmento intracavernoso da carótida interna associado a doença renal policística autossômica dominante: relato de caso

“…Grande número dessas lesões permanece assintomática, e HSA se torna uma preocupação somente quando o aneurisma ultrapassa o anel dural distal da carótida, projetandose para o espaço subaracnóideo intradural 3,5,11 . Em 2 estudos, totalizando 90 pacientes, o risco de HSA foi de apenas 0,4% por paciente-ano 4,12 .…”

“…São tratados os aneurismas intracavernosos que se apresentam com ruptura aguda, compressão de nervos cranianos, episódios tromboembóli-cos ou, nos pacientes assintomáticos, quando o aneurisma se estende ao espaço subaracnóideo extracavernoso, elevando o risco de sangramento [2][3][4][5][11][12][13]24 .…”

“…Entre eles, 3-5% ocorrem na porção intracavernosa da artéria carótida interna 2 . Aproximadamente um terço dos pacientes com aneurismas intracavernosos são assintomáticos ao diagnóstico, um terço tem cefaléia e metade tem alguma anormalidade de nervo craniano (III, IV, V 1 , V 2 e VI) 3 . Esses aneurismas podem, com menor freqüência, promover sintomas também por meio de ruptura, o que pode conduzir a uma fís-tula carótido-cavernosa, a uma hemorragia subaracnóidea (HSA) ou, ainda, a uma grave epistaxe 4,5 .…”

Bilateral Cavernous Internal Carotid Aneurysms in a Child with Juvenile Paget Disease and Osteoprotegerin Deficiency

“…3 Bilateral cavernous carotid artery aneurysms are clinically uncommon conditions. 4 To our knowledge, the association of juvenile Paget disease with cerebral aneurysms has not previously been described. Regardless of the mechanism of vascular wall abnormality, the marked bone remodeling of juvenile Paget disease may additionally contribute to, or permit, the prominent size of the aneuryms and deformity of the skull base in the present patient.…”

Flow Diversion versus Traditional Endovascular Coiling Therapy: Design of the Prospective LARGE Aneurysm Randomized Trial

“…Historically, the treatment of very large and giant aneurysms has focused on deconstructive approaches in which the parent artery bearing the aneurysm is occluded, or complex microsurgical procedures requiring flow arrest with clip reconstruction or entailing bypass strategies to distal-downstream cerebral circulation. [9][10][11] This requires that a patient has ample collateral channels to compensate for the occlusion of the artery supplying the aneurysm and typically this must be confirmed by a test balloon occlusion. 12,13 This method of aneurysm treatment yields an immediate and durable cure of the lesion treated and has been shown to have an acceptable safety profile with morbidity and mortality rates ranging from 0%-16%.…”