Extradural approach to intracavernous ICA aneurysms

A series of 115 intracavernous internal carotid artery (ICA) aneurysms have been treated by a direct surgical approach during the past 15 years. Sixty-eight aneurysms were small. Of these 11 were traumatic; nine caused by severe head injury and 2 by ICA injury during transsphenoidal surgery. Twenty-six aneurysms were large and 21 were giant. Thirty-eight aneurysms were clipped, 46 were treated by resection followed by ICA wall reconstruction with interrupted sutures, 16 by excision and proximal/distal ICA end-to-end anastomosis and 15 by resection/grafting. Postoperative angiography was performed in 107 cases and the ICA was found to be patent in 100 of these. Three patients died after surgery, two (with traumatic aneurysms) from associated brain injury and 1 from pulmonary embolism. Oculomotor palsy was present in the immediate postoperative period in 104 patients. However, six months after surgery only 7 patients had residual palsy. The direct surgical approach to intracavernous ICA aneurysms has constantly been changed and improved. The approach in its original version [6] was mainly intradural, whereas its contemporary version in most cases is extradural [10, 11]. The latter approach provides complete exposure of the entire parasellar region, good proximal control of the ICA [13], and good access to the cavernous sinus through the individual "corridors" between the cranial nerves [7]. In the author's opinion the direct surgical approach provides better results than endovascular treatment with regard to patency of the ICA [11].