Internal carotid artery occlusion for cavernous segment aneurysm.

Area of Science:

• Neurosurgery
• Vascular Neurology
• Interventional Radiology

Background:

• Symptomatic aneurysms in the cavernous segment of the internal carotid artery (ICA) pose significant clinical challenges.
• These aneurysms, particularly large ones (>3 cm), can cause symptoms like ophthalmoplegia, retro-orbital pain, and facial paresthesia.

Purpose of the Study:

• To review the experience with cervical internal carotid artery (ICA) occlusion for treating symptomatic cavernous segment aneurysms.
• To evaluate the safety and efficacy of ICA occlusion in this patient cohort.

Main Methods:

• Retrospective review of 15 patients with symptomatic cavernous ICA aneurysms treated with ICA occlusion.
• Procedures included gradual ICA occlusion with Selverstone clamp, ICA ligation, and aneurysm trapping.
• Cerebral blood flow monitoring, electroencephalography, and anticoagulation were employed as needed.

Main Results:

• Nine out of 15 patients had no postoperative clinical change; two showed improvement in ophthalmoplegia and three in facial pain.
• Three patients developed transient extraocular muscle palsies that resolved within a week.
• Long-term follow-up (5-6 years) showed 11 patients remained neurologically stable.

Conclusions:

• Cervical internal carotid artery (ICA) occlusion is a viable treatment option for symptomatic cavernous segment aneurysms.
• While transient complications can occur, long-term neurological stability is achievable for most patients.
• Further research may explore optimizing patient selection and procedural techniques.