Abstract
With recent advances in both microneurosurgery and intravascular surgery, excellent results of the treatment of a giant intracavernous aneurysm have been reported in the literature. However, there have still been some reported morbidities such as postoperative ophthalmoplegia or cerebral ischemia.
We present 2 cases of a giant aneurysm in the cavernous sinus that could not be treated suclcessfully either by direct surgery or by intravascular surgery.
Case 1 is a 73-year-old female with left ophthalmoplegia. Direct surgery was carried on for an intracavernous giant aneurysm. Unexpected massive bleeding occurred by aneurysmectomy even after temporary occlusion at C2 and C5, possibly due to incomplete C5 occlusion. Particularly in case of a giant aneurysm, which commonly accompanies a tough and sclerotic wall of the carotid artery, wider exposure of the C5 portion and occlution of it remote from the aneurysmal neck is mandatory. Preparation of cervical carotid artery would be a safer procedure.
Case 2 is a 60-year-old female, whose intracavernous large aneurysm was treated by internal balloon trapping at C4 and cervical ICA, resulting in fatal cerebral infarction due to postoperative thrombosis in spite of anticoagulant therapy. The use of an antithrombogenic material for balloon occlusion of parent arteries needs to be discussed. Use of Silicone may cause postoperative thrombosis less frequently than Latex. The necessity of bypass surgery in spite of the negative carotid occlusion test should also be discussed.
Surgical indications for intracavernous giant aneurysm only with slight symptoms of ophthalmoplegia should be carefully considered.
