Intracavernous Aneurysms, Their Characteristics, and Rate of Growth: An Analysis of 104 Aneurysms

Carotid cavernous aneurysms (CCAs) are rare aneurysms of the cavernous segment of the internal carotid artery. We aim to analyze the growth and characteristics of CCAs from a large single-hospital cohort.

We retrospectively reviewed untreated CCAs diagnosed between 1977 and 2014. The images were prospectively reviewed until year 2024. Aneurysm size, morphology, and etiology were assessed by an experienced neuroradiologist using available digital subtraction angiography, computed tomography angiography, or magnetic resonance angiography studies. Follow-up imaging data were used to assess aneurysm growth. Univariate analyses were performed to identify predictors of aneurysm growth. Receiver operating characteristic (ROC) analysis was used to determine the optimal size threshold for predicting neurological deficit at presentation and aneurysm growth.

We analyzed 104 CCAs in 90 patients (median age 54.5 years; 77% women). Most aneurysms were small (55%) and saccular (82%). Neurological deficits at presentation were associated with aneurysm size ≥13.5 mm (area under the ROC curve 0.93). Follow-up imaging was available for 46 CCAs over a median of 8.0 years. Aneurysm growth occurred in 65% of cases, with an incidence of 7.7% per person-year and a median annual growth rate of 0.10 mm. Initial aneurysm size was the only predictor of growth, with a 21% increased risk per millimeter (optimal cutoff 6.5 mm; area under the ROC curve 0.65).

CCAs are typically small, saccular, and asymptomatic, with low rupture risk. Follow-up of medium-sized CCAs is recommended, with treatment decisions based also on growth, morphology, and clinical symptoms.