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Objective Cavernous carotid aneurysms are considered benign lesions with indolent natural history. Apart from idiopathic aneurysms, traumatic, iatrogenic, and mycotic aneurysms are common in the cavernous segment of the carotid artery. With rapid advances in endovascular therapy, management of cavernous carotid aneurysms has evolved. Our aim was to review the management options available for cavernous carotid aneurysms. Methods The English literature was searched for various studies describing the management of cavernous carotid aneurysms and the evolution of various treatments was studied. Results Numerous treatment options are available such as conservative management, Hunterian ligation, surgical clipping, and endovascular therapy. The introduction of flow-diverting stents has revolutionized the management of these lesions. The evolution of various treatment strategies are described. Conclusions A thorough knowledge of all the options is paramount to individualize therapy. We discuss the indications of treatment, various management options for cavernous carotid aneurysms and their outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Background: Treatment of VLGUIA remains a challenge. To reduce mass effect and achieve complete occlusion, open surgery has been our favored treatment. However, endovascular therapy is preferred for lesions in the cavernous sinus or for older patients with complicating medical problems. The goal of this study is to investigate outcome of stent and/or coil treatment of VLGUIA. Methods: Beginning in 2002, the neuroform stent has been available to the University of Texas Southwestern Medical Center in Dallas. Since then until 2006, 15 patients were treated for VLGUIA with stenting and/or coiling at this institution. These 15 patients were used for a retrospective analysis in this study. Results: Median patient age was 65 years, median aneurysm size was 27 mm (20-37 mm), and median follow-up time was 22 months. Eight aneurysms were localized in the cavernous sinus and 7 at the ophthalmic segment of the internal carotid artery. Four aneurysms were completely occluded (100%); 3 aneurysms, nearly complete (90%-99%); and 8 aneurysms, partial (<90% occlusion). Twelve patients required retreatment. Final GOS was 1 (good recovery) in 11 patients, 2 (moderate disability) in 3 patients, and 3 (severely disabled) in 1 patient. No patient died or deteriorated. Conclusions: Stent/coil management of VLGUIA is constantly evolving. Current treatment results are promising, with very low morbidity/mortality. Disadvantage is the frequent persistence of residual aneurysm. [Copyright &y& Elsevier]

Abstract: We report on a patient with subacute ruptured intracavernous carotid artery aneurysm presenting with nonspecific features of cavernous sinus thrombophlebitis initially, leading to delayed diagnosis. It alerts our awareness of the potential causes and consequences of cavernous sinus thrombophlebitis, in particular in the presence of complicating internal carotid artery aneurysm and hence, the importance of angiographic evaluation. The increased risk of thrombogenic event from coexisting inflammation raises difficulty in endovascular coiling of aneurysm, which would be further aggravated with presence of stent due to potential risk of stent infection from local spread, as demonstrated in our case with complicated parent artery occlusion due to in-stent thrombus formation during the procedure. Adequate antithrombotic therapy at both before and after the procedure is required and regular follow-up is mandatory. [ABSTRACT FROM AUTHOR]