Abstract
Cavernous carotid aneurysm (CCA) often causes cranial nerve symptoms via its mass effect. Because performing direct surgery is difficult anatomically, internal carotid artery (ICA) occlusion (i.e., parent artery occlusion [PAO]) is performed as an effective treatment for symptom improvement. However, bypass surgery is sometimes necessary depending on the results of the examination for cerebral blood-flow reserve.
PAO with or without bypass surgery is associated with a risk of ischemic complications during the perioperative period and during the long-term postoperative period. The indications for endosaccular coil embolization (ESC), which permits ICA patency with a relatively lower risk, have expanded with its approved use for intracranial stenting. However, because the mass effect of the aneurysm remains, the level of improvement of symptoms with the use of ESC is uncertain compared with that with the use of PAO.
In 10 CCA cases, we performed PAO with high-flow bypass in 2 cases, PAO with low-flow bypass in 2, ESC without stenting in 3, and ESC with stenting in 3. With PAO, the neurological symptoms improved, but ischemic complications occurred in a case for which PAO was performed with high-flow bypass. With ESC, although no ischemic complications occurred, the neurological symptoms did not improve in 2 cases.
Currently, the PAO-based procedure is the first choice for symptomatic CCAs. However, according to therapeutic purposes, ESC, which is less invasive and carries a lower risk of complications, could be applied. Furthermore, it seemed to be a potentially useful treatment for preventing the progression of asymptomatic cases.
