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Matricidal cavernous aneurysms: a multicenter case series
- Source :
- Journal of neurointerventional surgery. 11(6)
- Publication Year :
- 2018
-
Abstract
- BackgroundCavernous carotid artery aneurysms (CCAs) represent a unique subset of intracranial aneurysms due to their distinct natural history and the anatomy of the cavernous sinus. Enlarging CCAs can cause elastic compression of the parent internal carotid artery (ICA). We suggest defining aneurysms that cause luminal stenosis of their parent vessels as ‘matricidal aneurysms.’Though many patients are asymptomatic, presenting symptoms of CCAs include ophthalmoplegia with resulting diplopia, vision changes, pain, ptosis, facial numbness, and cavernous-carotid fistula. Less commonly, patients with CCAs can present with epistaxis, subarachnoid hemorrhage, and—in cases of matricidal aneurysms—ischemia due to stenosis. The proper management of stenosis caused by a matricidal CCA is not well established and may not be intuitive.MethodsWe present a multicenter retrospective case series of patients with matricidal CCAs.ResultsForty patients with matricidal aneurysms presented with both asymptomatic and symptomatic stenosis. These patients were either treated with conservative medical management, coiling, flow diversion, or endovascular sacrifice of the parent artery. Planned treatment modalities were not executed in 11 cases (28% treatment failure rate). Presenting symptoms, patient outcomes, and follow-up data are presented for all cases.ConclusionMatricidal aneurysms require careful consideration and planning. The restricted anatomy of the cavernous sinus can make successful execution of endovascular interventions more difficult. Direct elastic compression of the parent artery does not respond to angioplasty and stenting in the same way atherosclerotic stenosis does. Because of this, planning for the possibility of parent vessel sacrifice is important.
- Subjects :
- Adult
Carotid Artery Diseases
Male
medicine.medical_specialty
Subarachnoid hemorrhage
Adolescent
Fistula
medicine.medical_treatment
030218 nuclear medicine & medical imaging
03 medical and health sciences
Young Adult
0302 clinical medicine
Aneurysm
medicine.artery
Angioplasty
medicine
Humans
cardiovascular diseases
Child
Aged
Retrospective Studies
Diplopia
Aged, 80 and over
business.industry
Intracranial Aneurysm
General Medicine
Middle Aged
medicine.disease
Embolization, Therapeutic
Surgery
Stenosis
030220 oncology & carcinogenesis
Cavernous sinus
cardiovascular system
Cavernous Sinus
Female
Stents
Neurology (clinical)
Radiology
Internal carotid artery
medicine.symptom
business
Carotid Artery, Internal
Subjects
Details
- ISSN :
- 17598486
- Volume :
- 11
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- Journal of neurointerventional surgery
- Accession number :
- edsair.doi.dedup.....86cbd605085bd09ff56276a280d3c416