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Abstract
to evaluate the endovascular treatment of vascular lesions of the cavernous segment of the internal carotidartery (ICA) performed at our institution. we conducted a descriptive, retrospective and prospective study of patients with aneurysms of the cavernous portion of the ICA or with direct carotid-cavernous fistulas (dCCF) undergoing endovascular treatment. we included 26 patients with intracavernous aneurysms and ten with dCCF. All aneurysms were treated with ICA occlusion. Those with dCCF were treated with occlusion in seven cases and with selective fistula occlusion in the remaining three. There was improvement of pain and ocular proptosis in all patients with dCCF. In patients with intracavernous aneurysms, the incidence of retro-orbital pain fell from 84.6% to 30.8% after treatment. The endovascular treatment decreased the dysfunction of affected cranial nerves in both groups, especially the oculomotor one. the endovascular treatment significantly improved the symptoms in the patients studied, especially those related to pain and oculomotor nerve dysfunction. avaliar o tratamento endovascular de lesões vasculares da artéria carótida interna (ACI), segmento cavernoso, realizado na Santa Casa de São Paulo. estudo descritivo, retrospectivo e prospectivo, de pacientes com aneurisma da porção cavernosa da ACI ou com fístulas carótido-cavernosas diretas (FCCd) submetidos a tratamento endovascular. foram incluídos 26 pacientes com aneurismas intracavernosos e dez com FCCd. Todos os aneurismas foram tratados com oclusão da ACI. Os com FCCd foram tratados com oclusão, em sete casos, e com oclusão seletiva da fístula nos outros três. Houve melhora da dor e proptose ocular em todos os pacientes com FCCd. Nos pacientes com aneurisma intracavernoso, a incidência de dor retro-orbitária caiu de 84,6% para 30,8% após o tratamento. Após o tratamento endovascular houve uma melhora importante da disfunção de nervos cranianos afetados em ambos os grupos, sobretudo no nervo oculomotor. o tratamento endovascular trouxe melhora para os pacientes deste estudo, especialmente nos critérios dor e acometimento do nervo oculomotor.
Highlights
The treatment of lesions that compromise the cavernous sinus (CS) represents a challenge to neurosurgeons
The increasing knowledge of the topographic anatomy related to the internal carotid artery (ICA) and its relationships with bones, dura mater (DM), venous spaces and cranial nerves (CN) changed the course of neurosurgical performance in CS lesions[1]
Retrospective and prospective study in which we evaluated 39 patients with intracavernous aneurysms (IcCAA) and direct carotidcavernous fistulas, of whom 36 underwent endovascular treatment in the period of January 1, 2009 to December 31, 2012
Summary
The treatment of lesions that compromise the cavernous sinus (CS) represents a challenge to neurosurgeons. Since Dolenc[1] has comprehensively described the microsurgical anatomy, knowledge of the CS region has spread, allowing the development of new treatment techniques. The increasing knowledge of the topographic anatomy related to the internal carotid artery (ICA) and its relationships with bones, dura mater (DM), venous spaces and cranial nerves (CN) changed the course of neurosurgical performance in CS lesions[1]. The development of modern neuroendocrine intervention techniques has widened the range of therapeutic options for vascular affections compromising the CS.
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