Giant Cavernous Internal Carotid Artery Research Articles

Challenging access during flow diversion treatment of a giant cavernous ICA aneurysm.

A man in his 60s presented with severe ophthalmoparesis and loss of visual acuity in his right eye. He was found to have a giant aneurysm of the cavernous internal carotid artery (ICA). Treatment with a flow diverter was recommended. The aneurysm caused matricidal outflow restriction of the ICA. Microwire and microcatheter access through the aneurysm was challenging, requiring multiple wires, stentriever reduction, and more. Eventually, a construct of 3 Pipeline embolization devices was created across the aneurysm. Troubleshooting access across giant aneurysms is an important part of treatment. Informed consent was obtained for the procedure and for publication. The video can be found here: https://stream.cadmore.media/r10.3171/2022.7.FOCVID2258.

Spontaneous thrombosis of internal carotid artery with occlusion of giant cavernous carotid aneurysm and malignant hemispheric infarct – Cure or curse?

Spontaneous thrombosis of giant intracranial aneurysm with parent artery occlusion is uncommon. We present an unusual case of a 28-year-old female who presented with a hemispheric infarct probably secondary to dissection of the cervical internal carotid artery (ICA). The cervical ICA occlusion simultaneously induced total thrombosis of pre-existing incidental giant cavernous ICA aneurysm. We discuss the various theories and probable mechanisms involved.

Successful Treatment of Giant Intracranial Aneurysm Using Flow-Diverter Device: First Experience in Nepal.

Giant intracranial aneurysms are defined as aneurysms that measure over 25 mm in the greatest dimension. They are rare vascular lesions that preferentially involve regions with high-velocity blood flow, such as the cavernous and supraclinoid segments of the internal carotid artery, the middle cerebral artery, the vertebrobasilar region, and the basilar apex. The treatment of giant aneurysms is challenging and associated with high rates of morbidity and mortality. Flow-diverter devices have revolutionized their treatment in recent times. We report the successful management of two patients with giant cavernous internal carotid artery aneurysms using flow-diverter devices for the first time in Nepal. Keywords: Endovascular; flow-diverter devices; giant aneurysm.

Extracranial-Intracranial High-Flow Bypass with Internal Carotid Artery Ligation at Neck for Giant Cavernous Internal Carotid Artery Dissecting Aneurysm in a Teen Girl with Postoperative Unusual Complication of Mono-ocular Blindness: A Case Report

AbstractExtracranial-intracranial (EC-IC) high-flow bypass with internal carotid artery (ICA) ligation at the neck is an important treatment option for giant cavernous ICA dissecting aneurysm. Such treatment may be associated with many complications. We report a case that developed postoperative mono-ocular blindness. So far to our knowledge such complication has not been reported in the literature. A 14-year-old girl presented with recent headache, eye ache, occasional double vision, and occasional right-sided visual impairment. Neurologic examination revealed no abnormality. Computed tomographic (CT) scan of the head showed a large, right parasellar, and mostly hyperdense space-occupying lesion. CT angiogram of the brain showed giant dissecting aneurysm of right-sided cavernous segment ICA. A right-sided external carotid artery–radial artery graft–middle cerebral artery (ECA-RAG-MCA [M2]) high-flow bypass was done with ligation of the right ICA in the neck. Postoperatively, the patient developed complete, mono-ocular, and permanent blindness on right side. Mono-ocular blindness is a serious complication from ophthalmic/central retinal artery thrombosis in high-flow EC-IC bypass with ICA ligation. Strategy is required to find and to set for its prevention.

Complete resolution of large intracranial aneurysm and cranial nerve deficits after endovascular treatment in an infant with tuberous sclerosis

Abstract Pediatric intracranial aneurysms are a rare entity, with an often reported prevalence ranging from 0.5% to 4.6%. Their etiology is poorly understood; however, their association with other congenital disorders, such as polycystic kidney disease and Marfan syndrome, has been widely documented in the pediatric neurosurgical literature. We present a case of a 9-month-old boy with tuberous sclerosis with a giant cavernous internal carotid artery aneurysm presenting with third nerve palsy.

Cranial Nerve Palsy after Embolization of Giant Cavernosu Carotid Aneurysms with Onyx HD-500: Case Series and Review of the Literature

Background Onyx liquid embolic system has been used in the treatment of intracranial aneurysm and arteriovenous malformation since 1999. Recently, Onyx HD-500 has been especially advocated for the treatment of large and giant intracranial aneurysms. Methods Two cases of cranial nerve palsy following embolization of unruptured symptomatic giant cavernous internal carotid artery aneurysms are presented. The first patient had a right 2.0cm x 1.5cm cavernous aneurysm, and the second a 2.7cm x 1.8cm left cavernous aneurysm. Both patients developed persistent diplopia after embolization with Onyx HD-500. Results Ophthalmological evaluation revealed that both patients had abductor nerve palsy on the same side as the aneurysm; in addition the second patient also had ipsilateral occulomotor nerve palsy. Conclusion Embolization of giant cavernous aneurysm with Onyx HD-500 can result in worsening or development of new cranial nerve palsies; possibly from mass effect resulting from edema and thrombosis of the aneurysm in the cavernous sinus.

Retrograde Trans-Posterior Communicating Artery Snare-Assisted Rescue of Lost Access to a Foreshortened Pipeline Embolization Device: Complication Management

The Pipeline embolization device (PED; Covidien Vascular Therapies, Mansfield, Massachusetts) is a promising, yet experimental, vascular reconstruction device for the treatment of complex intracranial aneurysms. We present a PED-related complication and describe a salvage strategy. A 64-year-old woman underwent PED-assisted parent vessel reconstruction for her giant cavernous internal carotid artery (ICA) aneurysm. During placement of the first PED, the proximal part of the PED foreshortened and was displaced into the aneurysm sac. Multiple subsequent attempts to recatheterize the PED failed, and, ultimately, distal access through and beyond the PED was lost. Therefore, completion of the Pipeline construct by stacking PEDs for definitive treatment was prevented. Retrograde access of the PED was gained from the distal ICA through a microwire that was advanced from the basilar artery through the posterior communicating artery. The microwire from the distal ICA was grasped with a snare from the proximal ICA and pulled down to the cervical ICA. The opened snare around the microwire was used as a lasso to advance a microcatheter from the cervical ICA through the PED to regain distal access. Five more PEDs were used to achieve complete parent vessel reconstruction and aneurysm obliteration. Maintaining distal access is critical until the entire parent vessel is reconstructed, especially when multiple PEDs are required. The salvage technique described may help regain distal access if it is lost during the procedure.

Case Report: Carotid-cavernous fistula due to aneurysmal rupture in a case of aortoaortitis with bilateral giant internal carotid artery aneurysms

Takayasu aortoarteritis (TA) rarely affects the nervous system, but when it does, it usually manifests as cerebral ischemia or stroke. These strokes have mainly been attributed to stenotic extracranial vessels. Stenoses of intracranial vessels, although rare in TA, can occur due to either embolization into the vessel or because of the vasculitic process itself. Intracranial aneurysms are very rare in patients with TA. Bilateral cavernous internal carotid artery (ICA) aneurysms are rarer. They have been reported following radiation therapy and in association with fibromuscular dysplasia and juvenile Paget disease. Bilateral mycotic intracavernous aneurysms also occur. Bilateral giant cavernous ICA aneurysms with carotid-cavernous fistula (CCF) consequent to rupture into the cavernous sinus in a case of TA are extremely unusual. We report a case that fulfilled both American College of Rheumatology and European League against Rheumatology criteria for TA. The patient had bilateral cavernous sinus giant aneurysms and CCF because the right-sided aneurysm had ruptured and was leaking into the cavernous sinus.

Stent Graft Placement for the Treatment of Giant Aneurysm at the Proximal Cavernous Internal Carotid Artery

Cavernous giant aneurysm is a challenging lesion for both surgical and endovascular treatments. Using a skull base technique, some cavernous internal carotid artery (ICA) aneurysms are directly clipped. However, larger aneurysms frequently lead to adverse effects during and after the operation. Endovascular treatment of cavernous ICA aneurysm consists of endosaccular coil placement and permanent ICA occlusion with or without EC-IC bypass1,2,3. Endosaccular occlusion of giant aneurysm has been proven less efficient because of coil compaction and/or regrowth of aneurysm. We report a case of giant cavernous ICA aneurysm treated with stent graft placement.