Abstract
Aneurysms detected in the cavernous sinus are usually asymptomatic. Before surgical intervention for an asymptomatic aneurysm is decided on, the following should be considered : 1 ) The natural course of an asymptomatic aneurysm in the cavernous sinus is generally benign. 2 ) Surgical complications including cranial nerve palsy are frequent. 3 ) The incidence of rupture causing subarachnoid hemorrhage is unclear. Asymptomatic aneurysms in the cavernous sinus were detected in 23 patients. All cases were followed up without treatment for 1.7-9.4 years (mean, 4.6 years). In the 23 patlents, 29 aneurysms were observed : 22 in the C3 segment, 5 in the C4 segment and 2 in the C5 segment. Seventeen of the C3 aneurysms with medial projection (which might cause subarachnoid hemorrhage) were detected in 14 patients. None of the patients in the cases which were followed up have developed symptoms due to the aneurysm in the cavernous sinus during the follow-up period. The complication rate and mortality among 123 patients who underwent direct surgery were calculated using published data to be 17.1% and 3.3%, respectively. These results indicate that surgery shound not always be recommended. Surgical intervention for an asymptomatic aneurysm in the cavernous sinus should be recommended only when symptoms are presented.
