Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
J Neurointerv Surg. 2010 Dec;2(4):359-62. doi: 10.1136/jnis.2010.003137.
Cavernous carotid aneurysms (CCAs) can present with visual symptoms or with subarachnoid hemorrhage (SAH). As surgical treatment of these aneurysms can be technically challenging, endovascular management has emerged as the preferred treatment modality.
A retrospective review was conducted of 113 patients who underwent endosaccular treatment for CCAs. Presenting symptoms, aneurysm size, use of stent assistance, rate of thromboembolic complications, presence of SAH and angiographic follow-up were reviewed.
29 patients (26%) with CCAs presented with diplopia due to cranial nerve palsies. Mean aneurysm size in this group was 17 mm. Three patients (2.6%) presented with SAH with a mean aneurysm size of 15.3 mm. Mean length of stay for ruptured versus non-ruptured aneurysms was 11.7 and 1.7 days, respectively. Clinically significant thromboembolic complications occurred in four cases (3.5%). Stent assistance was required in 53 cases (47%). Of the 86 patients (76%) returning for follow-up angiography (mean 6.2 months), 58 (75%) had no residual aneurysm and 14 (12%) showed regrowth. Thirteen patients (11.5%) underwent repeat endovascular treatment.
CCAs commonly produce diplopia and cranial nerve palsies when a critical size is reached (mean 17 mm in our series). Aneurysm obliteration with internal carotid artery preservation is the preferred treatment modality and can be accomplished with coil embolization with or without stent assistance. Although recurrence and retreatment can occur, the thromboembolic risk of endovascular treatment is low. Consideration should be given to treatment of asymptomatic CCAs 15 mm or larger due to potential risks of cranial neuropathy and SAH.
海绵状颈动脉动脉瘤（CCAs）可表现为视觉症状或蛛网膜下腔出血（SAH）。由于这些动脉瘤的手术治疗可能具有技术挑战性，因此血管内治疗已成为首选的治疗方式。
回顾性分析了 113 例接受腔内治疗 CCAs 的患者。回顾了发病症状、动脉瘤大小、支架辅助使用、血栓栓塞并发症发生率、SAH 存在情况和血管造影随访情况。
29 例（26%）CCAs 患者因颅神经麻痹出现复视。该组的平均动脉瘤大小为 17mm。3 例（2.6%）出现 SAH，平均动脉瘤大小为 15.3mm。破裂与未破裂动脉瘤的平均住院时间分别为 11.7 和 1.7 天。4 例（3.5%）发生临床显著血栓栓塞并发症。53 例（47%）需要支架辅助。86 例（76%）返回进行随访血管造影的患者（平均 6.2 个月）中，58 例（75%）无残留动脉瘤，14 例（12%）显示再生长。13 例（11.5%）患者接受了再次血管内治疗。
当达到临界大小时，CCAs 通常会产生复视和颅神经麻痹（在我们的系列中平均为 17mm）。保留颈内动脉的动脉瘤闭塞是首选的治疗方式，可以通过线圈栓塞联合或不联合支架辅助来完成。尽管可能会发生复发和再次治疗，但血管内治疗的血栓栓塞风险较低。由于潜在的颅神经病变和 SAH 风险，应考虑治疗无症状的 15mm 或更大的 CCAs。
