Abstract
Asymptomatic aneurysms of the C2-C3 portion of the internal carotid artery were discovered in 13 cases. Before surgical intervention for these lesions is decided on, the following factors should be considered: 1) Surgical technique is more difficult than in the other lesions. 2) Surgical outcome is not always good. 3) The relationship between aneurysm and cavernous sinus is complicated. 4) The incidence of rupture is not yet clear. 5) It is sometimes difficult to confirm whether the aneurysm is located in the cavernous sinus or not. Thirteen cases were analyzed with special reference to the angiographical findings and prognosis.
Seven patients underwent surgery for clipping. In this group, 4 patients had C2 aneurysm and 3 patients had C3 aneurysm. Intraoperative findings suggested that the C3 aneurysm was located in the cavernous sinus and C2 in the subarachnoid space. Surgical outcome was as follows: 4 in ADL 1, 1 in ADL 2 and 2 in ADL 3. Two patients developed ipsilateral blindness postoperatively.
Six other patients were followed without treatment for 1 to 8 years (mean, 3.6 years). In the followed patients, 2 had C2 aneurysm and 4 had C3 aneurysm. Two aneurysms seemed to be located in the subarachnoid space, 4 in the cavernous sinus. None of the unoperated patients have developed a symptom due to C2-C3 aneurysm.
These results indicate that surgery is not always recommended. Surgical intervention for intracavernous aneurysm should be especially limited.
