The benign course of cavernous carotid artery aneurysms

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✓ Recently, the benign nature of aneurysms of the cavernous carotid artery has been questioned. In a review of cases evaluated from 1980 to 1990 with this developmental aneurysm, the authors found 70 patients with 79 cavernous carotid artery aneurysms. As expected, the great majority (59 patients) had ophthalmoplegia as the initial problem. Retro-orbital pain (three cases) and a carotid-cavernous fistula (five cases) were infrequently the sole manifestation. Mirror-image asymptomatic aneurysms were found in nine patients and asymptomatic cavernous aneurysms were found in three additional patients. Thirty-four patients not surgically treated were followed for a mean of 2.8 years, and 36 surgical patients were followed for a mean of 4.1 years prior to treatment. Of the 79 aneurysms, one (1.3%) ruptured into the subarachnoid space during this period. Other than optic neuropathy or cranial neuropathy, no patient had a permanent neurological deficit; the 12 asymptomatic aneurysms remained asymptomatic. It is concluded that an aneurysm of the cavernous carotid artery is rarely associated with life-threatening complications, and treatment should be considered principally for patients with intolerable pain or problems related to vision.

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Address reprint requests to: Mark J. Kupersmith, M.D., 530 First Avenue 3B, New York, New York 10016.

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    Left: Initial T1-weighted magnetic resonance image, coronal view, demonstrating an intradural flow-void nipple (arrow) projecting through the dura from a left cavernous carotid artery aneurysm. Center: Subtracted left internal carotid angiogram, lateral view, is also suggestive of an intradural extension (arrow) of the aneurysm. Right: Angiogram using the calibrated-leak technique, lateral view, clearly demonstrating the intradural extension of the aneurysm lumen (wide arrow) that appeared to be pinched by the dura (thin arrow). Right internal carotid arteriography (not shown) demonstrated a lack of cross filling to the left cerebral hemisphere.

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