Presentation, Natural History, and Management of Carotid Cavernous Aneurysms

Author:

Stiebel-Kalish Hadas1,Kalish Yuval2,Bar-On Ruth Huna3,Setton Avi4,Niimi Yasu4,Berenstein Alejandro4,Kupersmith Mark J.5

Affiliation:

1. Neuro-Ophthalmology Service, Rabin Medical Center, Petah Tikva, Israel

2. Department of Psychology, Melbourne University, Melbourne, Australia

3. Neuro-Ophthalmology Service, Department of Ophthalmology, Sheba Medical Center, Ramat Gan, Israel

4. Endovascular Service, Roosevelt Hospital, New York, New York

5. Endovascular Service, Roosevelt Hospital, and Neuro-Ophthalmology Service, Institute of Neurology and Neurosurgery, Roosevelt Hospital, Albert Einstein School of Medicine, New York, New York

Abstract

Abstract OBJECTIVE: We present the largest reported cohort of carotid cavernous aneurysms (CCA), comparing the neuro-ophthalmic presentation, complications, and outcome with and without endovascular treatment. METHODS: Retrospective review of 185 patients with 206 CCAs examined between 1980 and 2001 at a tertiary neuro-ophthalmology and neurovascular service. Patients' symptoms and findings at presentation were recorded and compared with those at outcome. The effect of treatment on outcome and on complication rate was analyzed using the χ2 test, multivariate analysis of covariance, model-selection log-linear analysis, and multinomial logistic regression. RESULTS: Long-term follow-up was available for 189 of 206 CCAs. Seventy-four CCAs underwent treatment (endovascular, 67 [91%]; surgical treatment, 6 [9%]), and 115 were followed for an average of 4 years, two of which required later treatment. Treatment reduced the incidence and severity of pain, even after adjusting for the severity of initial pain (F(1,192 = 9.59, P = 0.002). Treatment did not significantly affect the patient's final diplopia after adjusting for their initial diplopia (F(1, 182 = 2.01, P = 0.158). Statistical examination revealed that the treated group had a higher proportion of neurological and visual complications than people who were not treated (2(2). = 25.26, P = 0.0003). CONCLUSION: Endovascular treatment of carotid cavernous aneurysms leads to a significantly higher rate of pain resolution compared with untreated patients, even after adjusting for initial pain severity. Diplopia may not resolve after treatment. The results of this study underscore our approach indicating treatment only in cases of debilitating pain, visual loss from compression, or diplopia in primary gaze or in patients with risk factors for major complications such as pre-existing coagulopathy or sphenoid sinus erosion.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Clinical Neurology,Surgery

Reference11 articles.

1. Endovascular therapy of idiopathic cavernous aneurysms over 11 years;Bavinzski;AJNR Am J Neuroradiol,1998

2. Surgery of Vertebrobasilar Aneurysms;Drake,1996

3. Long term visual and neurological prognosis in patients with treated and untreated cavernous sinus aneurysms;Goldenberg-Cohen;J Neurol Neurosurg Psychiatry,2004

4. Endovascular and surgical treatment of unruptured cerebral aneurysms: Comparison of risks;Johnston;Ann Neurol,2000

5. Aneurysms involving the motor and sensory visual pathways;Kupersmith,1993

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