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Lawrence Strenger

implications of referred pain are obvious. Postoperative nonvisualization of the lesion at angiography may not mean that it has really collapsed. Interference with the small vessels arising from the intracavernous carotid artery 12 such as the artery to Meckel's cave may have caused local ischemia. This seems unlikely considering the available anastomoses and the patency of the parent and adjacent vessels. Although the pathophysiology is admittedly cnigmatic, the mechanical concept of traction by eollapse of the thrombosed sac seems most tenable. Summary We have

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William M. Chadduck

unusually placed aneurysm. Dissections of the cavernous sinus in cadavers exposed a possible mechanism for the oculomotor palsy. The carotid aneurysm pointed medially in its subclinoid but extra-cavernous position, pressing against bone, and laterally displaced the distal intracavernous part of the carotid artery. As shown in Fig. 2 , slight lateral displacement of the most distal portion of the intracavernous carotid artery will impinge upon the intracavernous course of the third nerve, and will affect none of the other cranial nerves. The fact that ptosis and

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Raymond M. Taniguchi, John A. Goree and Guy L. Odom

: tentorial, dorsal meningeal, and inferior hypophyseal. The tentorial branch is directed posteriorly and laterally to supply the tentorium and falx, while the dorsal meningeal (or clival) branch goes inferiorly and posteromedially down the clivus to anastomose with its fellow on the opposite side. The inferior hypophyseal branch courses anteromedially or medially to supply the posterior lobe of the pituitary gland and dura over the floor of the sella. The second branch of the intracavernous carotid artery, seen in 80% of Parkinson's dissections, is the artery to the

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Hugo A. Krayenbühl, M. Gazi Yaşargil, Eugene S. Flamm and John M. Tew Jr.

carotid artery and 12 with aneurysms of the basilar artery, 231 patients had intradural aneurysms of the anterior circle of Willis. Most aneurysms had bled one or more times. There were eight exceptions: one aneurysm of the middle cerebral artery presented as a mass, four aneurysms of the posterior communicating artery presented with isolated third nerve palsies, and three internal carotid artery aneurysms presented with seizures in two cases and with symptoms of chiasmal compression in the other. The ages of the patients and the distribution of the aneurysms are shown

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Sixto Obrador, Juan Gomez-Bueno and Javier Silvela

dissection was difficult and some small intracavernous branches were damaged. In the posteroinferior portion of the intracavernous carotid a small, round, ruptured aneurysm, 3 to 4 mm in diameter, was found at the point of origin of the meningohypophyseal branch. The aneurysm was surrounded by many widely dilated venous channels inside the cavernous cavity ( Fig. 3 ). Fig. 3. Autopsy photograph ( left ) and drawing ( right ) of the right cavernous sinus showing the ruptured aneurysm (R.A.) of the intracavernous carotid artery (I.C.C.) at the level of the

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Anatomy of the cavernous sinus

A microsurgical study

Frank S. Harris and Albert L. Rhoton Jr.

line in the areas where it is out of view in the petrous bone and in the cavernous sinus. The tortuous artery obliterates the posterosuperior and medial venous space but the anteroinferior space is seen in the concavity of the initial curve of the carotid artery within the sinus. Fig. 2. Superolateral view of right cavernous sinus showing the pituitary gland, carotid artery, and second through sixth cranial nerves (CN II through VI). Upper: CN III and IV enter the roof of the cavernous sinus and CN VI enters posteriorly. The intracavernous carotid

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Stephen Nutik

for a partially intradural and partially intracavernous location, respectively. Other radiographic features suggested the dual location of the aneurysms. The origin of the ophthalmic artery is known to be intradural in about 90% of cases. 5, 14 In most of the present cases, the ophthalmic artery arose more proximally on the carotid than the most proximal part of the aneurysm. Another feature that indicated an intracavernous location was that in many of the cases the fundus of the aneurysm superimposed on the intracavernous carotid artery on the lateral angiogram

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José M. Cabezudo, Rafael Carrillo, Jesús Vaquero, Eduardo Areitio and Roberto Martinez

lacerated when attempting to open the anterior wall of the sella. An iatrogenic aneurysm of the artery rapidly developed, initially causing symptoms of cavernous sinus involvement, and later producing epistaxis when it ruptured into the paranasal sinuses. Rapid development of traumatic intracranial aneurysms, as in our case, has been reported previously. 20, 27, 33, 34 Traumatic or iatrogenic rupture of the intracavernous carotid artery leading to carotid-cavernous fistula is well known. 4, 7, 11, 30 For epistaxis to occur, the wall of the cavernous sinus must be torn

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Richard H. Britt, Gerald D. Silverberg, Donald J. Prolo and Michael M. Kendrick

T he anatomical variations of the location of the intracavernous carotid artery make the artery vulnerable to possible laceration, perforation, or avulsion during the course of transsphenoidal hypophysectomy. 1, 9, 14, 23 Fortunately, this complication has rarely been experienced. 2, 5, 6, 11, 19, 30 The patient presented here experienced brisk arterial hemorrhage during transsphenoidal hypophysectomy. The technique of using a double-lumen Prolo balloon catheter * to occlude the site of hemorrhage is described. Case Report This 58-year-old woman was

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Richard P. Mills, Sam J. Insalaco and Allen Joseph

intracranial pressure dynamics and/or toxicity of the anesthetic agents (pentobarbital, nitrous oxide, and fentanyl) might have precipitated the ophthalmoplegia. In contrast to the more common cavernous sinus meningiomas and aneurysms, which predictably show abnormalities on plain skull films or CT scans, 9 diagnosis of intracavernous metastasis is usually difficult. The only abnormality suggesting the metastasis is frequently a subtle distortion of the intracavernous carotid artery, 3, 8, 11 although the artery itself is remarkably resistant to tumor invasion. 10 In