Giant cavernous carotid aneurysms: Clinical presentation in fifty-seven cases

Objectives: To review the presenting symptoms and ophthalmic findings of 57 patients with cavernous carotid aneurysms of giant size (greater than or e qual to2.5-cm diameter). Materials and Methods: Hospital charts of 57 patients with giant cavernous carotid aneurysms who presented to University Hospital in London, Ontario, Canada between 1961 and 1993 were reviewed. All patients were proven by cer ebral angiography to have unruptured giant cavernous carotid aneurysms. Results: Forty-six patients (81%) were women (mean age, 54 years). The most common presenting symptoms were diplopia (89%), retroorbital pain (61%), h eadache (19%), diminished or blurred vision (14%), and photophobia (4%). Th e most common clinical sign was partial or complete ophthalmoplegia (93%). Trigeminal nerve involvement was found in 37% of patients. Other clinical s igns included ptosis, decreased visual acuity, proptosis, and visual field defects. Conclusions: This study characterizes a large group of patients with giant cavernous carotid aneurysms seen over a 30-year period at a single institut ion. As in previous studies, diplopia and retroorbital pain were the most c ommon symptoms. The high incidence of ophthalmoplegia observed in this stud y may be explained by a greater compressive and/or ischemic effect of giant aneurysms compared with their smaller counterparts.