Microsurgical and Endovascular Treatment of Giant Intracavernous Aneurysms

Treatment of giant intracavernous carotid artery aneurysms (ICCA), rare but formidable challenging lesions, requires scrupulous review of the clinical and radiographic studies and involves several different or successive surgical approaches. To attain complete permanent exclusion of the ICCAs from the circulation while preserving the parent carotids, microsurgical or endovascular techniques should be employed. Three kinds of surgical approaches can be addressed: (1) direct surgical aneurysm obliteration with parent artery preservation, (2) indirect obliteration using parent artery sacrifice, and (3) indirect aneurysm obliteration followed by extracranial-to-intracranial bypass or interposition grafts. In most instances, however, endovascular intervention with or without vessel reconstruction is now the initial treatment. When one considers parent carotid occlusion, balloon test occlusion should be performed irrespective of surgical options.