The elegant up-to-date technique of the detachable balloon catheter introduced via an arterial and/or venous route has resulted in occlusion of CCF's and preservation of carotid artery patency in over half the cases so treated.4 Thrombogenic techniques provide the ultimate treatment with which CCF's can be excluded and the ICA function preserved.16 Carotidcavernous fistulas were treated by a direct surgical approach and occlusion of the fistula by clipping as much as 20 years before the introduction of extracorporeal circulation and cardiac arrest.2 Cardiac arrest and hypothermia afforded safer conditions for a direct approach to vascular lesions located in the CS.12,17 The time available for the direct repair of the intracavernous ICA with the patient under cardiac arrest and deep hypothermia is relatively short, however, even for the most experienced surgeon.17
In the treatment of intracavernous aneurysms of the ICA and CCF's, selective occlusion of the lesion with preservation of carotid artery patency and avoidance of operative trauma to the third through sixth cranial nerves is the method of choice. Using the combination of a pterional28 and subtemporal approach6 and the exposure of the intrapetrous portion of the carotid artery,9 we have managed to achieve a safe direct approach to the CS without the addition of circulatory arrest and deep hypothermia.
Johnston I: Direct surgical treatment of bilateral intracavernous internal carotid artery aneurysms. Case report. J Neurosurg 51:98–1021979Johnston I: Direct surgical treatment of bilateral intracavernous internal carotid artery aneurysms. Case report. J Neurosurg 51:
Parkinson D: Carotid cavernous fistula: direct repair with preservation of the carotid artery. Technical note. J Neurosurg 38:99–1061973Parkinson D: Carotid cavernous fistula: direct repair with preservation of the carotid artery. Technical note. J Neurosurg 38:
This paper was presented at the Seventh International Congress of Neurological Surgery, July 12–18, 1981, Munich, Germany.