Direct microsurgical repair of intracavernous vascular lesions

Three patients with aneurysms of the internal carotid artery (ICA) situated in the cavernous sinus (CS), and four patients with traumatic carotid-cavernous fistulas (CCF's) were treated by direct surgical approach. Two aneurysms were clipped, whereas the third (a giant aneurysm) was resected and the wall of the ICA reconstructed using interrupted sutures. In two CCF's, the shunt was excluded during reconstruction of the ICA wall by suturing. In the remaining two patients with CCF's, the shunt was excluded by clipping. The CS was attacked directly using a combination of three different techniques: the pterional, the subtemporal, and the petrosal approach. The ICA in its whole course through the CS, as well as the third through the sixth cranial nerves, were exposed. No special measures, such as hypotension, hypothermia, extracorporeal circulation and cardiac arrest, or dehydration, were taken during surgery. The aim of the direct approach to the CS was to exclude the aneurysm and/or the CCF and preserve the ICA patency. In all seven cases operated on, the lesions were excluded without inflicting any additional damage to the third through sixth cranial nerves, and in five cases carotid patency was preserved.