抄録
Nine giant aneurysms at the cavernous portion were experienced from 1973 to 1983. Surgical treatment was performed in eight cases, while one was treated conservatively. Common carotid clamping was undertaken in seven cases and aneurysmorrhaphy following internal carotid trapping was undertaken in seven cases and aneurysmorrhaphy following internal carotid trapping in one. During the follow-up study, eight patients were living useful lives, seven with clamping and one with aneurysmorrhaphy. Giant aneurysms were classified into three types by CT scan and angiographical findings. Type I was nonthrombosed, Type II was partially thrombosed, and Type II was totally thrombosed. Each of these was analyzed for postoperative change of clinical symptoms and morphological change on sequential CT scan. Follow-up periods were from one year to five years and 10 months.
As for the three Type II cases, the lumen of the aneurysm diminished in one, but remained unchanged in two after clamping; preexisting oculomotor nerve palsy in two cases and abducent nerve palsy in one case totally recovered. On the other hand, as for Type II, the lumen of the aneurysm disappeared in all three cases about one year after clamping. Oculomotor nerve palsy partially recovered in one case, but preexisting ophthalmoplegia was unchanged in two. One patient developed transient ischemic accident.
One case of Type III, which was tumorous aneurysm, must have been managed by aneurysmorrhaphy for removal of mass effect and symptomatic brain compression diminished after the operation. It was reflected that preexisting intraaneurysmal thrombosis altered the effect of common carotid clamped. The method of treatment for IC cavernous aneurysms are reviewed with respect to this classification.
