Abstract
Background and Objective: Giant cavernous carotid artery aneurysms (CCAAs) often produce a variety of neurological deficits, primarily those related to ophthalmoplegia/paresis and headache. This study was designed to evaluate the resolution of symptoms after parent artery occlusion (PAO) treatment for giant CCAAs. Methods: We retrospectively reviewed a series of 17 consecutive giant CCAAs treated with PAO treatment. All patients were evaluated by balloon occlusion test (BOT) before treatment. Patients who could tolerate BOT were treated by PAO. The following outcomes were analyzed: angiographic assessment, evolution of symptoms and outcome at clinical follow-up using modified Rankin Scale (mRS). Results: A total number of 17 giant CCAAs were treated by PAO. The initial post-procedure and follow-up angiogram revealed complete occlusion in all patients, no new lesion was detected. Periprocedural infarcts occurred in 1 patient (5.9%). Procedure-related mortality and morbidity were 0% and 5.9%, respectively. At mean 31.8 months clinical follow-up, symptoms had disappeared in 7 (41.2%) of the patients, partially improved in 5 (29.4%), remained unchanged in 4 (23.5%) and worsened in 1 (5.9%) of cases. Sixteen (94.1%) patients presented a good clinical outcome (mRS 0 - 1). Conclusion: Most patients in our series improved or remained stable after PAO. The results of this study indicate that PAO can improve the outcome of those symptomatic giant CCAAs if BOT can be tolerated.
Highlights
Giant cavernous carotid artery aneurysms (CCAAs) are defined as larger than 25 mm and they most often produce mass effects [1]
parent artery occlusion (PAO) is a well-established technique for the treatment of giant CCAAs if balloon occlusion test (BOT) can be tolerated [5] [6], its efficacy concerning resolution of symptoms has not yet been adequately assessed, which to our knowledge, is likely due to the limited number of patients included in studies that have been reported in the literature
The purpose of our study was to evaluate the evolution of symptoms after PAO treatment for giant CCAAs in this series of patients
Summary
Giant CCAAs are defined as larger than 25 mm and they most often produce mass effects [1] Such effects are likely due to compression of the adjacent third to sixth cranial nerves which can result in symptoms such as headache, ophthalmoplegia or facial pain. Surgical treatment of these aneurysms is challenging due to their location often involving the cavernous sinus region and the dysplastic characteristic of the parent artery in case of dissecting lesions [2]. The results of this study indicate that PAO can improve the outcome of those symptomatic giant CCAAs if BOT can be tolerated
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