Aneurysms of the intracavernous carotid artery: a multidisciplinary approach to treatment

Mark E. Linskey Departments of Neurological Surgery and Radiology, University of Pittsburgh School of Medicine and Presbyterian-University Hospital, Pittsburgh, Pennsylvania

Search for other papers by Mark E. Linskey in
Current site
Google Scholar
PubMed
Close
 M.D.
,
Laligam N. Sekhar Departments of Neurological Surgery and Radiology, University of Pittsburgh School of Medicine and Presbyterian-University Hospital, Pittsburgh, Pennsylvania

Search for other papers by Laligam N. Sekhar in
Current site
Google Scholar
PubMed
Close
 M.D.
,
Joseph A. Horton Departments of Neurological Surgery and Radiology, University of Pittsburgh School of Medicine and Presbyterian-University Hospital, Pittsburgh, Pennsylvania

Search for other papers by Joseph A. Horton in
Current site
Google Scholar
PubMed
Close
 M.D.
,
William L. Hirsch Jr. Departments of Neurological Surgery and Radiology, University of Pittsburgh School of Medicine and Presbyterian-University Hospital, Pittsburgh, Pennsylvania

Search for other papers by William L. Hirsch Jr. in
Current site
Google Scholar
PubMed
Close
 M.D.
, and
Howard Yonas Departments of Neurological Surgery and Radiology, University of Pittsburgh School of Medicine and Presbyterian-University Hospital, Pittsburgh, Pennsylvania

Search for other papers by Howard Yonas in
Current site
Google Scholar
PubMed
Close
 M.D.
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $525.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $624.00
USD  $45.00
USD  $525.00
USD  $624.00
Print or Print + Online Sign in

✓ Of 43 cavernous sinus aneurysms diagnosed over 6½ years, 23 fulfilled indications for treatment; of these 19 were treated, eight surgically and 11 with interventional radiological techniques. Six small and two giant aneurysms were treated surgically: four were clipped, two were repaired primarily, and two were trapped with placement of a saphenous-vein bypass graft. Seven large and four giant aneurysms were treated with interventional radiological techniques: in five cases the proximal internal carotid artery (ICA) was sacrificed; one aneurysm was trapped with detachable balloons; and five were embolized with preservation of the ICA lumen. The mean follow-up period was 25 months. At follow-up examination, three patients in the surgical group were asymptomatic, two had improved, and three had worsened. Three of these patients had asymptomatic infarctions apparent on computerized tomography (CT) scans. At follow-up examination, four radiologically treated patients were asymptomatic, five had improved, two were unchanged, and none had worsened. One patient had asymptomatic and one minimally symptomatic infarction apparent on CT scans; both lesions were embolic foci after aneurysm embolization with preservation of the ICA.

It is concluded that treatment risk depends more on the adequacy of collateral circulation than on the size of the aneurysm. A multidisciplinary treatment protocol for these aneurysms is described, dividing patients into high-, moderate-, and low-risk groups based on pretreatment evaluation of the risk of temporary or permanent ICA occlusion using a clinical balloon test occlusion coupled with an ICA-occluded stable xenon/CT cerebral blood flow study. Radiological techniques are suggested for most low-risk patients, while direct surgical techniques are proposed for most moderate- and high-risk patients.

  • Collapse
  • Expand
  • 1.

    Afifi AK, , Godersky JC, & Menezes A, et al: Cerebral hemiatrophy, hypoplasia of the internal carotid artery, and intracranial aneurysm: a rare association occurring in an infant. Arch Neurol 44:232235, 1987 Afifi AK, Godersky JC, Menezes A, et al: Cerebral hemiatrophy, hypoplasia of the internal carotid artery, and intracranial aneurysm: a rare association occurring in an infant. Arch Neurol 44:232–235, 1987

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Andrews JC, , Valavanis A, & Fisch U: Management of the internal carotid artery in surgery of the skull base. Laryngoscope 99:12241229, 1989 Andrews JC, Valavanis A, Fisch U: Management of the internal carotid artery in surgery of the skull base. Laryngoscope 99:1224–1229, 1989

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Barnett HJ: Delayed cerebral ischemic episodes distal to occlusion of major cerebral arteries. Neurology 28:769774, 1978 Barnett HJ: Delayed cerebral ischemic episodes distal to occlusion of major cerebral arteries. Neurology 28:769–774, 1978

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Batjer H, , Mickey B, & Samson D: Enlargement and rupture of distal basilar artery aneurysm after iatrogenic carotid occlusion. Neurosurgery 20:624628, 1987 Batjer H, Mickey B, Samson D: Enlargement and rupture of distal basilar artery aneurysm after iatrogenic carotid occlusion. Neurosurgery 20:624–628, 1987

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Berenstein A, , Ransohoff J, & Kupersmith M, et al: Transvascular treatment of giant aneurysms of the cavernous carotid and vertebral arteries. Functional investigation and embolization. Surg Neurol 21:312, 1984 Berenstein A, Ransohoff J, Kupersmith M, et al: Transvascular treatment of giant aneurysms of the cavernous carotid and vertebral arteries. Functional investigation and embolization. Surg Neurol 21:3–12, 1984

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Brackett CE Jr: The complications of carotid artery ligation in the neck. J Neurosurg 10:91106, 1953 Brackett CE Jr: The complications of carotid artery ligation in the neck. J Neurosurg 10:91–106, 1953

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Branston NM, , Strong AJ, & Symon L: Kinetics of resolution of transient increases in extracellular potassium activity: relationship to regional blood flow. Neurol Res 4:119, 1982 Branston NM, Strong AJ, Symon L: Kinetics of resolution of transient increases in extracellular potassium activity: relationship to regional blood flow. Neurol Res 4:1–19, 1982

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Debrun G, , Fox A, & Drake C, et al: Giant unclipped aneurysms: treatment with detachable balloons. AJNR 2:167173, 1981 Debrun G, Fox A, Drake C, et al: Giant unclipped aneurysms: treatment with detachable balloons. AJNR 2:167–173, 1981

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    De Morais JV, & Lanna-Peixoto MA: Bilateral intracavernous carotid aneurysms: treatment by bilateral carotid ligation. Surg Neurol 9:379381, 1978 De Morais JV, Lanna-Peixoto MA: Bilateral intracavernous carotid aneurysms: treatment by bilateral carotid ligation. Surg Neurol 9:379–381, 1978

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    deVries EJ, , Sekhar LN, & Horton JA, et al: A new method to predict safe resection of the internal carotid artery. Laryngoscope 100:8588, 1990 deVries EJ, Sekhar LN, Horton JA, et al: A new method to predict safe resection of the internal carotid artery. Laryngoscope 100:85–88, 1990

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Diaz FG, , Ohaegbulam S, & Dujovny M, et al: Surgical alternatives in the treatment of cavernous sinus aneurysms. J Neurosurg 71:846853, 1989 Diaz FG, Ohaegbulam S, Dujovny M, et al: Surgical alternatives in the treatment of cavernous sinus aneurysms. J Neurosurg 71:846–853, 1989

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Dolenc V: Direct microsurgical repair of intracavernous vascular lesions. J Neurosurg 58:824831, 1983 Dolenc V: Direct microsurgical repair of intracavernous vascular lesions. J Neurosurg 58:824–831, 1983

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Dolenc V: Surgery of vascular lesions of the cavernous sinus. Clin Neurosurg 36:240255, 1988 Dolenc V: Surgery of vascular lesions of the cavernous sinus. Clin Neurosurg 36:240–255, 1988

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Dyste GN, & Beck DW: De novo aneurysm formation following carotid ligation: case report and review of the literature. Neurosurgery 24:8892, 1989 Dyste GN, Beck DW: De novo aneurysm formation following carotid ligation: case report and review of the literature. Neurosurgery 24:88–92, 1989

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Erba SM, , Horton JA, & Latchaw RE, et al: Balloon test occlusion of the internal carotid artery with stable xenon/ CT cerebral blood flow imaging. AJNR 9:533538, 1988 Erba SM, Horton JA, Latchaw RE, et al: Balloon test occlusion of the internal carotid artery with stable xenon/ CT cerebral blood flow imaging. AJNR 9:533–538, 1988

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Faria MA Jr, , Fleischer AS, & Spector RH: Bilateral giant intracavernous carotid aneurysms treated by bilateral carotid ligation. Surg Neurol 14:207210, 1980 Faria MA Jr, Fleischer AS, Spector RH: Bilateral giant intracavernous carotid aneurysms treated by bilateral carotid ligation. Surg Neurol 14:207–210, 1980

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Fox AJ: Comment on Liu MY, Shih CJ, Wang YC, et al: Traumatic intracavernous carotid aneurysm with massive epistaxis. Neurosurgery 17:573, 1985 Fox AJ: Comment on Liu MY, Shih CJ, Wang YC, et al: Traumatic intracavernous carotid aneurysm with massive epistaxis. Neurosurgery 17:573, 1985

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Fox AJ, , Viñuela F, & Pelz DM, et al: Use of detachable balloons for proximal artery occlusion in the treatment of unclippable cerebral aneurysms. J Neurosurg 66:4046, 1987 Fox AJ, Viñuela F, Pelz DM, et al: Use of detachable balloons for proximal artery occlusion in the treatment of unclippable cerebral aneurysms. J Neurosurg 66:40–46, 1987

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Gelber BR, & Sundt TM Jr: Treatment of intracavernous and giant carotid aneurysms by combined internal carotid ligation and extra- to intracranial bypass. J Neurosurg 52:110, 1980 Gelber BR, Sundt TM Jr: Treatment of intracavernous and giant carotid aneurysms by combined internal carotid ligation and extra- to intracranial bypass. J Neurosurg 52:1–10, 1980

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    German WJ, & Black SPW: Cervical ligation for internal carotid aneurysms. An extended follow-up. J Neurosurg 23:572577, 1965 German WJ, Black SPW: Cervical ligation for internal carotid aneurysms. An extended follow-up. J Neurosurg 23:572–577, 1965

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Gomensoro JB, , Maslenikov V, & Azambuga N, et al: Joint study of extracranial arterial occlusion. JAMA 244:985991, 1973 Gomensoro JB, Maslenikov V, Azambuga N, et al: Joint study of extracranial arterial occlusion. JAMA 244: 985–991, 1973

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Hargadine JR, , Branston NM, & Symon L: Central conduction time in primate brain ischemia — a study in baboons. Stroke 11:637642, 1980 Hargadine JR, Branston NM, Symon L: Central conduction time in primate brain ischemia — a study in baboons. Stroke 11:637–642, 1980

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Higashida RT, , Halbach VV, & Dowd C, et al: Endovascular detachable balloon embolization therapy of cavernous carotid artery aneurysms: results in 87 cases. J Neurosurg 72:857863, 1990 Higashida RT, Halbach VV, Dowd C, et al: Endovascular detachable balloon embolization therapy of cavernous carotid artery aneurysms: results in 87 cases. J Neurosurg 72:857–863, 1990

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Hodes JE, , Fox AJ, & Pelz DM, et al: Rupture of aneurysms following balloon embolization. J Neurosurg 72:567571, 1990 Hodes JE, Fox AJ, Pelz DM, et al: Rupture of aneurysms following balloon embolization. J Neurosurg 72:567–571, 1990

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Jones TH, , Morawetz RB, & Crowell RM, et al: Thresholds of focal cerebral ischemia in awake monkey. J Neurosurg 54:773782, 1981 Jones TH, Morawetz RB, Crowell RM, et al: Thresholds of focal cerebral ischemia in awake monkey. J Neurosurg 54:773–782, 1981

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Leech PJ, , Miller JD, & Fitch W, et al: Cerebral blood flow, internal carotid artery pressure, and the EEG as a guide to the safety of carotid ligation. J Neurol Neurosurg Psychiatry 37:854862, 1974 Leech PJ, Miller JD, Fitch W, et al: Cerebral blood flow, internal carotid artery pressure, and the EEG as a guide to the safety of carotid ligation. J Neurol Neurosurg Psychiatry 37:854–862, 1974

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Linskey ME, , Sekhar LN, & Hirsch W Jr, et al: Aneurysms of the intracavernous carotid artery: clinical presentation, radiographic features, and pathogenesis. Neurosurgery 26:7179, 1990 Linskey ME, Sekhar LN, Hirsch W Jr, et al: Aneurysms of the intracavernous carotid artery: clinical presentation, radiographic features, and pathogenesis. Neurosurgery 26: 71–79, 1990

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Linskey ME, , Sekhar LN, & Hirsch WL Jr, et al: Aneurysms of the intracavernous carotid artery: natural history and indications for treatment. Neurosurgery 26:933938, 1990 Linskey ME, Sekhar LN, Hirsch WL Jr, et al: Aneurysms of the intracavernous carotid artery: natural history and indications for treatment. Neurosurgery 26:933–938, 1990

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Little JR, , Rosenfeld JV, & Awad IA: Internal carotid artery occlusion for cavernous segment aneurysm. Neurosurgery 25:398404, 1989 Little JR, Rosenfeld JV, Awad IA: Internal carotid artery occlusion for cavernous segment aneurysm. Neurosurgery 25:398–404, 1989

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Liu MY, , Shih CJ, & Wang YC, et al: Traumatic intracavernous carotid aneurysm with massive epistaxis. Neurosurgery 17:569573, 1985 Liu MY, Shih CJ, Wang YC, et al: Traumatic intracavernous carotid aneurysm with massive epistaxis. Neurosurgery 17:569–573, 1985

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Matas R: Testing the efficiency of the collateral circulation as a preliminary to the occlusion of the great surgical arteries. JAMA 63:14411447, 1914 Matas R: Testing the efficiency of the collateral circulation as a preliminary to the occlusion of the great surgical arteries. JAMA 63:1441–1447, 1914

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Morioka M, , Matsushima T, & Fujii K, et al: Balloon test occlusion of the internal carotid artery with monitoring of compressed spectral arrays (CSAs) of electroencephalogram. Acta Neurochir 101:2934, 1989 Morioka M, Matsushima T, Fujii K, et al: Balloon test occlusion of the internal carotid artery with monitoring of compressed spectral arrays (CSAs) of electroencephalogram. Acta Neurochir 101:29–34, 1989

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Oldershaw JB, & Voris HC: Internal carotid artery ligation, a follow up study. Neurology 16:937368, 1966 Oldershaw JB, Voris HC: Internal carotid artery ligation, a follow up study. Neurology 16:937–368, 1966

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Olivecrona H: Ligature of the carotid artery in intracranial aneurysms. Acta Chir Scand 91:353368, 1944 Olivecrona H: Ligature of the carotid artery in intracranial aneurysms. Acta Chir Scand 91:353–368, 1944

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Parkinson D: Surgical approach to cavernous sinus aneurysms, in Pia HW, , Langmaid C, & Zierski J (eds): Cerebral Aneurysms. Advances in Diagnosis and Therapy. Berlin: Springer-Verlag, 1979, pp 224228 Parkinson D: Surgical approach to cavernous sinus aneurysms, in Pia HW, Langmaid C, Zierski J (eds): Cerebral Aneurysms. Advances in Diagnosis and Therapy. Berlin: Springer-Verlag, 1979, pp 224–228

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Perneczky A, , Knosp E, & Vorkapic P, et al: Direct surgical approach to infraclinoid aneurysms. Acta Neurochir 76:3644, 1985 Perneczky A, Knosp E, Vorkapic P, et al: Direct surgical approach to infraclinoid aneurysms. Acta Neurochir 76:36–44, 1985

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Poppen JL: Specific treatment of intracranial aneurysms. Experiences with 143 surgically treated patients. J Neurosurg 8:75102, 1951 Poppen JL: Specific treatment of intracranial aneurysms. Experiences with 143 surgically treated patients. J Neurosurg 8:75–102, 1951

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Quint DJ, , Boulos RS, & Spera TD: Congenital absence of the cervical and petrous internal carotid artery with intracavernous anastomosis. AJNR 10:435439, 1989 Quint DJ, Boulos RS, Spera TD: Congenital absence of the cervical and petrous internal carotid artery with intracavernous anastomosis. AJNR 10:435–439, 1989

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Scialfa G, , Vaghi A, & Valsecchi F, et al: Neuroradiological treatment of carotid and vertebral fistulas and intracavernous aneurysms. Neuroradiology 24:1325, 1982 Scialfa G, Vaghi A, Valsecchi F, et al: Neuroradiological treatment of carotid and vertebral fistulas and intracavernous aneurysms. Neuroradiology 24:13–25, 1982

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Sekhar LN, , Linskey ME, & Sen CN, et al: Surgical management of lesions within the cavernous sinus. Clin Neurosurg 37:440489, 1991 Sekhar LN, Linskey ME, Sen CN, et al: Surgical management of lesions within the cavernous sinus. Clin Neurosurg 37:440–489, 1991

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Sekhar LN, , Schramm VL Jr, & Jones NF et al: Operative exposure and management of the petrous and upper cervical carotid artery. Neurosurgery 19:967982, 1986 Sekhar LN, Schramm VL Jr, Jones NF et al: Operative exposure and management of the petrous and upper cervical carotid artery. Neurosurgery 19:967–982, 1986

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42.

    Sekhar LN, , Sen CN, & Jho HD: Saphenous vein graft bypass of the cavernous internal carotid artery. J Neurosurg 72:3541, 1990 Sekhar LN, Sen CN, Jho HD: Saphenous vein graft bypass of the cavernous internal carotid artery. J Neurosurg 72:35–41, 1990

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43.

    Sekhar LN, , Sen CN, & Jho HD, et al: Surgical treatment of intracavernous neoplasms: a four-year experience. Neurosurgery 24:1830, 1989 Sekhar LN, Sen CN, Jho HD, et al: Surgical treatment of intracavernous neoplasms: a four-year experience. Neurosurgery 24:18–30, 1989

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    Serbinenko FA: Balloon catheterization and occlusion of major cerebral vessels. J Neurosurg 41:125145, 1974 Serbinenko FA: Balloon catheterization and occlusion of major cerebral vessels. J Neurosurg 41:125–145, 1974

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45.

    Servo A: Agenesis of the left internal carotid artery associated with an aneurysm on the right carotid syphon. Case report. J Neurosurg 46:677680, 1977 Servo A: Agenesis of the left internal carotid artery associated with an aneurysm on the right carotid syphon. Case report. J Neurosurg 46:677–680, 1977

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46.

    Silvani V, , Rainoldi F, & Gaetani P, et al: Combined STA/MCA arterial bypass and gradual internal carotid artery occlusion for treatment of intracavernous and giant carotid artery aneurysms. Acta Neurochir 78:142147, 1985 Silvani V, Rainoldi F, Gaetani P, et al: Combined STA/MCA arterial bypass and gradual internal carotid artery occlusion for treatment of intracavernous and giant carotid artery aneurysms. Acta Neurochir 78:142–147, 1985

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47.

    Strother CM, , Lunde S, & Graves V, et al: Late paraophthalmic aneurysm rupture following endovascular treatment. Case report. J Neurosurg 71:777780, 1989 Strother CM, Lunde S, Graves V, et al: Late paraophthalmic aneurysm rupture following endovascular treatment. Case report. J Neurosurg 71:777–780, 1989

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48.

    Sundt TM Jr, , Sharbrough FW, & Anderson RE, et al: Cerebral blood flow measurements and electroencephalograms during carotid endarterectomy. J Neurosurg 41:310320, 1974 Sundt TM Jr, Sharbrough FW, Anderson RE. et al: Cerebral blood flow measurements and electroencephalograms during carotid endarterectomy. J Neurosurg 41:310–320, 1974

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49.

    Van Dellen JR: Intracavernous traumatic aneurysms. Surg Neurol 13:203207, 1980 Van Dellen JR: Intracavernous traumatic aneurysms. Surg Neurol 13:203–207, 1980

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50.

    Voris HC: Complications of ligation of the internal carotid artery. J Neurosurg 8:119131. 1951 Voris HC: Complications of ligation of the internal carotid artery. J Neurosurg 8:119–131. 1951

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 51.

    Weil SM, , van Loveren HR, & Tomsick TA, et al: Management of inoperable cerebral aneurysms by the navigational balloon technique. Neurosurgery 21:296302, 1987 Weil SM, van Loveren HR, Tomsick TA, et al: Management of inoperable cerebral aneurysms by the navigational balloon technique. Neurosurgery 21:296–302, 1987

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 52.

    Wilkinson E, , Spetzler RF, & Carter LP, et al: Intraoperative barbiturate therapy during temporary vessel occlusion in man, in Spetzler RF, , Carter LP, & Selman WR, et al (eds): Cerebral Revascularization For Stroke. New York: Thieme-Stratton, 1985, pp 397402 Wilkinson E, Spetzler RF, Carter LP, et al: Intraoperative barbiturate therapy during temporary vessel occlusion in man, in Spetzler RF, Carter LP, Selman WR, et al (eds): Cerebral Revascularization For Stroke. New York: Thieme-Stratton, 1985, pp 397–402

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 53.

    Winn HR, , Richardson AE, & Jane JA: Late morbidity and mortality of common carotid ligation for posterior communicating aneurysms. A comparison to conservative treatment. J Neurosurg 47:727736, 1977 Winn HR, Richardson AE, Jane JA: Late morbidity and mortality of common carotid ligation for posterior communicating aneurysms. A comparison to conservative treatment. J Neurosurg 47:727–736, 1977

    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 724 137 17
Full Text Views 460 29 5
PDF Downloads 165 21 1
EPUB Downloads 0 0 0