MEDICAL-MANAGEMENT IN THE ENDOVASCULAR TREATMENT OF CAROTID-CAVERNOUSANEURYSMS

Carotid-cavernous aneurysms account for between 1.9% and 9.0% of intra cranial aneurysms. Entirely intercavernous aneurysms are believed to h ave a relatively benign course, with cranial nerve findings or headach e being the usual initial symptomatology; however, subarachnoid hemorr hage or carotid-cavernous fistula formation can result from rupture. O ver the past 15 years endovascular parent artery occlusion has essenti ally replaced surgical carotid occlusion as the treatment of choice. T he authors describe a series of 39 consecutive patients at the Univers ity of Virginia Health Sciences Center who underwent endovascular trea tment of a carotid-cavernous aneurysm. Aggressive invasive hemodynamic monitoring and maintenance of a state of normo- to mild hypervolemia in the asymptomatic patient was used throughout the periprocedural per iod. Rapid institution of hypervolemic-hypertensive therapy can revers e early neurological deficits related to hypoperfusion in these patien ts. Only one individual managed with this protocol developed neurologi cal deficits not reversible with hypertensive-hypervolemic therapy. He parin therapy was administered for 48 hours after occlusion, with pati ents receiving subsequent aspirin therapy for 6 months to combat dista l embolism secondary to thrombosis. Long-term complications were not s een in patients receiving aneurysm trapping; however, two individuals with proximal carotid occlusion developed late optic neuropathy and on e had recurrent transient ischemic attacks that ceased with supraclino idal carotid clipping.