[Direct embolization with occluding spring embolus for large aneurysm and carotid-cavernous fistula]

The authors describe a technique using occluding spring emboli for direct obliteration of an unclippable large aneurysm, and carotid-cavernous fistula (CCF) which failed to be occluded by transarterial and transvenous approaches. Case 1: This 44 year-old man had a history of head trauma 30 years ago. He was admitted to our department on October 16, 1989, because of an aneurysm incidentally found by a CT scan taken for the examination of his vertigo. Angiograms revealed a large aneurysm at the C3 portion of the right internal carotid artery. A right frontal craniotomy was performed on November 2, 1989, but neck clipping of the aneurysm was impossible, because it was a pseudoaneurysm with quite a fragile neck. Subsequently, fourteen occluding spring emboli were inserted into the aneurysm through a polyethylene catheter directly into the aneurysmal dome. Postoperative angiograms showed almost complete obliteration of the aneurysm with good preservation of the parent artery. Case 2: This 26 year-old woman without a history of head trauma was admitted to our department on May 10, 1989, complaining of right conjunctival injection and exophthalmos. Angiograms revealed a spontaneous CCF which had a single orifice at the C4 portion of the right internal carotid artery and drained through the superior ophthalmic vein and inferior petrosal sinus. Initially, transarterial and transvenous approaches were tried, but the attempts were unsuccessful. Subsequently, a right frontotemporal craniotomy was performed on August 8, 1989, and 27 occluding spring emboli were placed into the cavernous sinus through a polyethylene catheter which had been inserted directly.(ABSTRACT TRUNCATED AT 250 WORDS)