Internal carotid aneurysms presenting with mass effect symptoms of cranial nerve dysfunction: efficacy and imitations...

The authors report a retrospective analysis of their experience in the endosaccular embolization of internal carotid aneurysms which caused mass effect symptoms of cranial nerves (CN) and review the efficacy and limitations of this technique.

Between April 1997 and August 2002, 12 internal carotid aneurysms that caused mass effect symptoms of CN were treated by endosaccular GDC embolization with parent artery preservation. The locations were the cavernous internal carotid artery (CV) in six patients, carotid-ophthalmic artery (CO) in two patients, and posterior communicating artery (PCo) in four patients. The angiographical size of the aneurysms ranged from 6 to 20 mm, with a mean of 13.3 mm. Duration of symptoms ranged from 0.5 to 120 months, with a mean of 13.7 months. All aneurysms were treated by endosaccular guglielmi detachable coil (GDC) embolization with preservation of the internal carotid artery.

Five patients (42%) had complete resolution of symptoms, four (33%) had significant improvement of symptoms, and three (25%) were unchanged. Immediate posttreatment angiographic studies revealed neck remnant (NR) in nine patients and dome filling (DF) in three patients. In one patient (case 10), the resolved symptoms became worse 29 months later. Follow-up angiograms were obtained in 10 patients, and recanalization was observed in four of them (40%). Transient thrombotic complication occurred in only one patient. The group with resolution or improvement of symptoms demonstrated a shorter duration of symptoms before GDC treatment (< or = 12 months).

Even subtotal endosaccular embolization of aneurysms may reduce mass effect symptoms of cranial nerves. However, careful follow-up is needed because subtotal occlusion carries a future risk of growth.