Management of Cavernous Carotid Artery Aneurysms: A Retrospective Single-Center Experience.

Ulf Nestler,Tim Wende,Johannes Kasper,Michael Karl Fehrenbach,Ulf Quaeschling,Eric Dietel,Juergen Meixensberger,Florian Wilhelmy,Caroline Sander

doi:10.3390/brainsci12030330

Ulf Nestler, Tim Wende + Show 7 more

Open Access

https://doi.org/10.3390/brainsci12030330

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Journal: Brain sciences	Publication Date: Feb 28, 2022
Citations: 2	License type: CC BY 4.0

Affiliation: University Hospital Leipzig

Abstract

Objective: While cavernous carotid aneurysms can cause neurological symptoms, their often-uneventful natural course and the increasing options of intravascular aneurysm closure call for educated decision-making. However, evidence-based guidelines are missing. Here, we report 64 patients with cavernous carotid aneurysms, their respective therapeutic strategies, and follow-up. Methods: We included all patients with cavernous carotid aneurysms who presented to our clinic between 2014 and 2020 and recorded comorbidities (elevated blood pressure, diabetes mellitus, and nicotine consumption), PHASES score, aneurysm site, size and shape, therapeutic strategy, neurological deficits, and clinical follow-up. Results: The mean age of the 64 patients (86% female) was 53 years, the mean follow-up time was 3.8 years. A total of 22 patients suffered from cranial nerve deficit. Of these patients, 50% showed a relief of symptoms regardless of the therapy regime. We found no significant correlations between aneurysm size or PHASES score and the occurrence of neurological symptoms. Conclusion: If aneurysm specific symptoms persist over a longer period of time, relief is difficult to achieve despite aneurysm treatment. Patients should be advised by experts in neurovascular centers, weighing the possibility of an uneventful course against the risks of treatment. In this regard, more detailed prospective data is needed to improve individual patient counseling.

Highlights

Cavernous carotid aneurysms (CCA) account for 2% to 9% of all intracranial aneurysms and are often considered benign due to their low risk of hemorrhage [1]
In addition to the risk of subarachnoid hemorrhage, their location within the sinus cavernous in proximity to cranial nerves can lead to impairment of ocular movement, carotico-cavernous fistula, or epistaxis [2–5]
While 13.3% of female patients suffered from diabetes, no male patients did. One woman in her 40s suffered from an aneurysmal subarachnoid hemorrhage WFNS

Summary

Introduction

Cavernous carotid aneurysms (CCA) account for 2% to 9% of all intracranial aneurysms and are often considered benign due to their low risk of hemorrhage [1]. In addition to the risk of subarachnoid hemorrhage, their location within the sinus cavernous in proximity to cranial nerves can lead to impairment of ocular movement, carotico-cavernous fistula, or epistaxis [2–5]. Most CCA remain incidental findings, with unspecific symptoms leading to cranial imaging and subsequent detection of the vascular pathology. A wide variety of neurovascular options exist, ranging from open surgical approaches to endovascular treatment [9–12]. The recent development of endovascular techniques, especially flow diversion, led to a change of preferred therapy options [13,14]. Complication rates during endovascular treatment are very low, the life-long antiplatelet therapy poses a specific risk down the line which is to be considered, especially in young patients [15–17].

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