Carotid cave aneurysms of the internal carotid artery

1989 ◽  
Vol 70 (2) ◽  
pp. 216-221 ◽  
Author(s):  
Shigeaki Kobayashi ◽  
Kazuhiko Kyoshima ◽  
Hirohiko Gibo ◽  
Sathyaranjandas A. Hegde ◽  
Toshiki Takemae ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Anterior Clinoid Process ◽  
Content Type ◽  
Blade Ring ◽  
Curved Blade ◽  
Anteroposterior View

✓ In a series of 32 surgical cases of carotid-ophthalmic artery aneurysm, seven of the lesions were located in the “carotid cave.” This special type of aneurysm is usually small and projects medially on the anteroposterior view of the angiogram. At surgery, it is located intradurally at the dural penetration of the internal carotid artery (ICA) on the ventromedial side, appears to be buried in the dural pouch (carotid cave), and is often difficult to find, dissect, and clip. The aneurysm extends into the cavernous sinus space, and the parent ICA penetrates the dural ring obliquely. An ipsilateral pterional approach was used in all 32 cases, and ring clips were used exclusively because the aneurysms were located ventromedially. Clipping was successful in five cases. All patients returned to their preoperative occupation, although vision worsened postoperatively in two cases. The technical steps required for successful obliteration of this aneurysm are summarized as follows: 1) exposure of the cervical ICA; 2) unroofing of the optic canal and removal of the anterior clinoid process; 3) exploration of the ICA around the dural ring and opening of the cavernous sinus; 4) direct retraction of the ICA and optic nerve; and 5) application of multiple ring clips to conform to the natural curvature of the carotid artery; a curved-blade ring clip is especially useful. The relevant topographic anatomy is discussed.

Mobilization of the internal carotid artery for basilar artery aneurysm surgery

1997 ◽  
Vol 86 (2) ◽  
pp. 294-296 ◽  
Author(s):  
Takeshi Matsuyama ◽  
Takahide Shimomura ◽  
Yoshinari Okumura ◽  
Toshisuke Sakaki
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Basilar Artery ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Optic Canal ◽  
Aneurysm Surgery ◽  
Anterior Clinoid Process ◽  
Content Type ◽  
Orbital Roof

✓ The authors describe a technique for mobilization of the internal carotid artery (ICA) for basilar artery (BA) aneurysm surgery. Using the epidural approach, the anterior clinoid process, orbital roof, and optic canal are drilled away. The ICA is made mobile to the C3 segment by cutting the dural ring and dissecting the ICA from the carotid groove. The ophthalmic artery is then dissected from the optic canal. This mobilization of the ICA secures wide operative fields on both its medial and lateral sides and permits complete clipping of BA aneurysms.

Subarachnoid hemorrhage possibly caused by a saccular carotid artery aneurysm within the cavernous sinus

1990 ◽  
Vol 73 (2) ◽  
pp. 301-304 ◽  
Author(s):  
Tatsuya Nishioka ◽  
Akinori Kondo ◽  
Ikuhiro Aoyama ◽  
Kiyoshi Nin ◽  
Jun Takahashi
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Surgical Approach ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Content Type ◽  
Carotid Artery Aneurysm ◽  
Fine Print

✓ Aneurysms arising from the intracavernous portion of the internal carotid artery very rarely rupture. A patient is presented in whom rupture of an aneurysm wholly within the cavernous sinus caused a subarachnoid hemorrhage. The aneurysm was successfully clipped via a direct surgical approach. The possible mechanism by which subarachnoid hemorrhage occurred is briefly discussed.

The superior wall of the cavernous sinus: a microanatomical study

1994 ◽  
Vol 81 (6) ◽  
pp. 914-920 ◽  
Author(s):  
Felix Umansky ◽  
Alberto Valarezo ◽  
Josef Elidan
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Deep Layer ◽  
Lateral Wall ◽  
Anterior Clinoid Process ◽  
Content Type ◽  
Carotid Canal ◽  
Fine Print

✓ The superior wall of the cavernous sinus was studied in 30 specimens obtained from 15 cadaver heads fixed in formalin. Trapezoidal in shape, the superior wall of cavernous sinus is limited laterally by the anterior petroclinoid ligament, medially by the dura of the diaphragma sellae, anteriorly by the endosteal dura of the carotid canal, and posteriorly by the posterior petroclinoid ligament. An interclinoid ligament bisects the wall, dividing it into two triangles: the carotid trigone anteromedially and the oculomotor trigone posterolaterally. Similar to the lateral wall of the cavernous sinus, the superior wall is formed by two layers: a smooth superficial dural layer and a thin, less defined deep layer. In the area of the carotid trigone, both layers separate to wrap the anterior clinoid process. The removal of this process will reveal a “clinoid space” medial to which the internal carotid artery can be identified. This clinoid segment of the artery, still extracavernous, is surrounded by two fibrous rings: a distal ring formed by fibers of the superficial dural layer and a proximal ring related to the deep dural layer. Below the proximal ring, the internal carotid artery becomes intracavernous; above the distal ring, the artery is continuous with its supraclinoid segment. The complex dural anatomy of the superior wall, its fibrous rings, and the clinoid space in relation to a superior surgical approach to the cavernous sinus are discussed.

Intracranial mycotic aneurysms of extravascular origin

1972 ◽  
Vol 36 (5) ◽  
pp. 552-559 ◽  
Author(s):  
Charas Suwanwela ◽  
Nitaya Suwanwela ◽  
Srisakul Charuchinda ◽  
Chaturaporn Hongsaprabhas
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Cerebral Arteries ◽  
Content Type ◽  
Mycotic Aneurysms ◽  
Fine Print

✓ Six patients with intracranial mycotic aneurysms of extravascular origin are reported. Four had aneurysms of the intracavernous portion of the internal carotid artery associated with thrombophlebitis of the cavernous sinus, and two had aneurysms of the cerebral arteries associated with meningitis. An aneurysm of this type may rupture, producing subarachnoid hemorrhage, or it may become thrombosed and decrease in size or spontaneously disappear. In some patients it may persist and develop calcification in the wall.

Treatment of bilateral spontaneous dural carotid-cavernous fistulas by coils and sclerotherapy

1987 ◽  
Vol 66 (3) ◽  
pp. 468-470 ◽  
Author(s):  
Patrick Courtheoux ◽  
Daniel Labbe ◽  
Christian Hamel ◽  
Pierre-Joel Lecoq ◽  
Marcio Jahara ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Superior Ophthalmic Vein ◽  
Content Type ◽  
Steel Coils ◽  
Carotid Cavernous Fistulas ◽  
Fine Print

✓ A case of bilateral spontaneous carotid-cavernous fistulas producing increased intraocular pressure is reported. The fistulas lay between the meningeal branches of the internal carotid artery (ICA) and the cavernous sinus, but the ICA itself was not involved. Successful treatment was accomplished by the introduction of steel coils and a sclerotic liquid into the cavernous sinus via the distal superior ophthalmic vein.

Republished: Spontaneous subarachnoid hemorrhage due to ruptured cavernous internal carotid artery aneurysm after medical prolactinoma treatment

2016 ◽  
Vol 9 (3) ◽  
pp. e9-e9 ◽  
Author(s):  
Siri Sahib Khalsa ◽  
Todd C Hollon ◽  
Ravi Shastri ◽  
Jonathan D Trobe ◽  
Joseph J Gemmete ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Aneurysm Rupture ◽  
Anterior Clinoid Process ◽  
Carotid Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
Anterior Cranial Base

Aneurysms of the cavernous segment of the internal carotid artery (ICA) are believed to have a low risk of subarachnoid haemorrhage (SAH), given the confines of the dural rings and the anterior clinoid process. The risk may be greater when the bony and dural protection has been eroded. We report a case of spontaneous SAH from rupture of a cavernous ICA aneurysm in a patient whose large prolactinoma had markedly decreased in size as the result of cabergoline treatment. After passing a balloon test occlusion, the patient underwent successful endovascular vessel deconstruction. This case suggests that an eroding skull base lesion may distort normal anterior cranial base anatomy and allow communication between the cavernous ICA and subarachnoid space. The potential for SAH due to cavernous ICA aneurysm rupture should be recognised in patients with previous pituitary or other skull base lesions adjacent to the cavernous sinus.

Surgical alternatives in the treatment of cavernous sinus aneurysms

1989 ◽  
Vol 71 (6) ◽  
pp. 846-853 ◽  
Author(s):  
Fernando G. Diaz ◽  
Sam Ohaegbulam ◽  
Manuel Dujovny ◽  
James I. Ausman
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Visual Loss ◽  
Internal Carotid ◽  
Content Type ◽  
Group 3 ◽  
Group 2 ◽  
Fine Print ◽  
Group 1

✓ Direct surgery on aneurysms in the cavernous sinus is a formidable technical procedure. The intimate relationship of the intracavernous carotid artery to the venous structures and to the cranial nerves make surgical access difficult at best. Thirty-two of 356 aneurysm patients presented with symptomatic aneurysms originating from the intracavernous internal carotid artery. Twenty-one patients had aneurysms contained entirely within the cavernous sinus, and in 11 others the aneurysms arose within the cavernous sinus and extended into the subarachnoid space. Of the purely intracavernous aneurysms there were five small aneurysms (< 25 mm) and 16 giant (≥ 25 mm) aneurysms. Fifteen patients with purely intracavernous lesions had a superior orbital fissure syndrome, and six had a variety of other symptoms. Of 11 patients with subarachnoid extension, five had a subarachnoid hemorrhage (Grade I or II), five had ipsilateral visual loss, and one had periorbital pain. The aneurysms were treated as follows: Group 1 received progressive ligation of the internal carotid artery in the neck with a Selverstone clamp and a surface superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis (purely intracavernous in nine, and with subarachnoid extension in one); Group 2 underwent trapping of the internal carotid artery and a deep STA-MCA anastomosis (purely intracavernous in seven); and Group 3 had direct clipping of the aneurysm (purely intracavernous in five, and with subarachnoid extension in 10). The cavernous sinus was entered directly through its roof by a pterional craniotomy with radical removal of the optic canal, lesser sphenoid wing, and lateral and superior orbital walls. Proximal control of the internal carotid artery was obtained through a cervical incision. Two patients in Group 1 developed transient neurological deficits, which resolved. Two patients in Group 2 developed a cerebral infarction, one of whom died; in both of these patients, the anastomosis was completed after the internal carotid artery occlusion. Two patients in Group 3 progressed from marked visual loss to blindness of the same side, and one developed an intraventricular hemorrhage during induction of anesthesia and died without surgery. It is proposed that a direct approach to symptomatic aneurysms in the cavernous sinus is the best initial alternative. When this approach is not feasible, a trapping procedure preceded by a high-flow extracranial-intracranial anastomosis may be considered. Although the authors have been able to clip aneurysms of various sizes, this has not been possible in all patients. Further work is needed in this area.

Common carotid to intracranial internal carotid bypass venous graft

1971 ◽  
Vol 34 (1) ◽  
pp. 114-118 ◽  
Author(s):  
William M. Lougheed ◽  
Brian M. Marshall ◽  
Michael Hunter ◽  
Ernest R. Michel ◽  
Harley Sandwith-Smyth
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Bypass Graft ◽  
Left Internal Carotid Artery ◽  
Anterior Clinoid Process ◽  
Content Type ◽  
The Common ◽  
The Right ◽  
Inside Out

✓ A 54-year-old woman was admitted with a complete occlusion of the right internal carotid artery and a 25% stenosis of the left internal carotid artery. Intracranial circulation on the right side was restored by taking a vein from the leg and anastomosing the vein of the intracranial carotid artery just distal to the anterior clinoid process. Prior to insertion the vein was turned inside out, the valves removed and then reinverted allowing the distal end of the vein to be anastomosed to the intracranial internal carotid artery. The blood flow was therefore reversed in the vein. The proximal end of the vein was anastomosed to the common carotid artery. Upon completion there was excellent circulation in the bypass graft and internal carotid artery.

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