Sattur Mithun, Saway Brian F, Lena Jonathan, Spiotta Alejandro
Department of Neurological Surgery, Medical University of South Carolina, Charleston, USA.
Cureus. 2021 Mar 1;13(3):e13643. doi: 10.7759/cureus.13643.
Cavernous carotid aneurysms (CCAs) are usually considered benign as the natural history of the condition is often asymptomatic; however, CCAs can reach giant proportions and become symptomatic, thus requiring treatment. The introduction of flow diverters has revolutionized management of this condition. However, the parent artery geometry in giant lesions may prove exceedingly difficult to navigate and deploy stents satisfactorily. In such cases, indirect surgical treatment such as proximal occlusion of internal carotid artery (ICA) should be employed. Preoperative balloon test occlusion is indicated before permanent occlusion to identify patients who demonstrate hemispheric ischemia (for possible bypass), but it requires understanding of important operative complications and technical nuances. Endovascular parent artery sacrifice is an effective modality to achieve proximal occlusion. Here, we describe the step-wise management approach in a 53-year-old female with a giant, left CCA presenting with headache and cavernous sinus syndrome who was ultimately successfully treated with endovascular coiling and ICA occlusion. The management of complex lesions such as giant skull base aneurysms requires a sound understanding of vascular anatomy, tools available for evaluation, and physiological interpretation of diagnostic and therapeutic modalities to obtain excellent clinical results and patient satisfaction.
海绵窦段颈内动脉瘤（CCAs）通常被认为是良性的，因为该疾病的自然病程往往无症状；然而，CCAs可能发展到巨大尺寸并出现症状，因此需要治疗。血流导向装置的引入彻底改变了这种疾病的治疗方式。然而，巨大病变中的母动脉解剖结构可能极难进行操作并令人满意地植入支架。在这种情况下，应采用间接手术治疗，如颈内动脉（ICA）近端闭塞。在永久性闭塞之前，需要进行术前球囊试验闭塞，以识别出现半球缺血的患者（可能需要进行搭桥手术），但这需要了解重要的手术并发症和技术细节。血管内母动脉牺牲是实现近端闭塞的一种有效方法。在此，我们描述了一名53岁女性患者的逐步治疗方法，该患者患有巨大的左侧CCAs，伴有头痛和海绵窦综合征，最终通过血管内栓塞和ICA闭塞成功治疗。对于复杂病变，如巨大颅底动脉瘤的治疗，需要对血管解剖结构、可用的评估工具以及诊断和治疗方式的生理学解释有深入的了解，以获得良好的临床效果和患者满意度。
