抄録
Nine cases of cavernous portion aneurysm (AN) were treated by direct surgery.
One AN was a persistent trigeminal artery AN at the C4-5 portion, five ANs were located at the C3 portion and the other three were ophthalmic ANs of the subchiasmal type at the C2 portion.
In four cases, subarachnoid hemorrhage occurred as a result of a saccular aneurysm located at the C2 portion (three cases) and at Acom accompanied by a C3 portion AN (one case). In two cases, epistaxis occurred as a result of a saccular aneurysm located at the C3 portion. In one case, ophthalmoplegia occurred suddenly. And in two other cases, aneurysms were incidentally discovered by angiography.
Operation was performed under normotensive, normothermic anesthesia in a half sitting position with the head lifted up by approximately 35°. In this position, it was easy to control venous bleeding from the cavernous sinus owing to reduction of venous pressure. Intraoperative monitoring was performed to evaluate cerebral blood flow (CBF), somatosensory evoked potential (SEP) and visual evoked potential (VEP).
The subtemportal approach was used for a C4-5 AN and the pterional approach was used for C2-3 ANs with the removal of the anterior clinoid process. Bleeding from the opened cavernous sinus was controlled with Oxycel packing. Doppler sonography was useful for checking on the patency of the internal carotid artery.
All nine aneurysms were clipped with no stenosis of the carotid artery. There was no major ischemic complication, but ipsilateral blindness (2 cases), ophthalmoplegia (1 case), transient oculomotor palsy (1 case) and transient CSF rhinorrhea (1 case) were observed.
Details of direct surgery on the nine cases of cavernous portion aneurysms are reported in this paper.
