High-flow bypass with radial artery graft for cavernous carotid aneurysms: A case series

Riki Tanaka; Boon Liew; Kento Sasaki; Kyosuke Miyatani; Tsukasa Kawase; Yasuhiro Yamada; Yoko Kato; Akihiko Horiguchi

doi:10.4103/ajns.AJNS_289_20

Asian Journal of Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(04): 863-869
DOI: 10.4103/ajns.AJNS_289_20

Original Article

High-flow bypass with radial artery graft for cavernous carotid aneurysms: A case series

Riki Tanaka

Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya

,

Boon Liew

Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya

,

Kento Sasaki

Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya

,

Kyosuke Miyatani

Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya

,

Tsukasa Kawase

Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya

,

Yasuhiro Yamada

Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya

,

Yoko Kato

Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya

,

Akihiko Horiguchi

¹Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, Nagoya

› Author Affiliations

Abstract

Background: The incidence of cavernous carotid aneurysms (CCAs) of intracranial aneurysms is low. Majority of cases presented as incidental findings with benign natural progression. The most common presenting symptoms are multiple cranial neuropathies among symptomatic patients. The treatment modalities for symptomatic patients include direct surgical clipping, endovascular coil embolization, or placement of flow diverter, or indirect procedures such as occlusion of parent artery with and without revascularization techniques. The advancement in the microsurgical treatments and endovascular devices have enable a high success rate in the treatment of patients with CCAs with low morbidity and mortality rates. Objective: To study the surgical outcomes of patients with cavernous aneurysm who underwent high-flow bypass between 2015 and 2020 in our institution. Materials and Methods: A total of six patients in a single institution presented with CCAs who were treated with high-flow bypass surgery were included in this case-series. A single-case illustration was presented focusing on the details of surgical case management of CCA. The intraoperative middle cerebral artery (MCA) pressure monitoring during bypass surgery was also described. Results: All five female patients and one male patient who were diagnosed with cavernous carotid aneurysms were studied. The mean age was 68.8 years old (range: 24-84 years old) and the mean size of the aneurysm was 19.6mm (range: 9.7 – 30mm). There were successfully treated with high flow bypasses using radial artery graft without any neurological sequelae. Conclusion: The surgical treatments of cavernous carotid aneurysms should be limited to experienced neurosurgeons in view of significant risk of morbidity and mortality. Endovascular procedures may be the main stay of treatments. The success shown in this case series with parent artery occlusion and bypass surgery may provide an safe alternative to the endovascular treatment.

Key-words:

Cavernous carotid aneurysms - high-flow bypass surgery - outcome

Full Text

References

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