Surgical Treatment for Aneurysms in the Cavernous - Petrous Portion of the Internal Carotid Artery

Background: As direct surgery to treat aneurysms in the cavernous-petrous portion of the ICA is difficult, proximal ligation of the ICA with or without bypass surgery is still the conventional treatment. Some patients have an ECA-ICA collateral pathway distal to the ligation site. This is related to the recanalization of the aneurysm. We describe the treatment strategy of these aneurysms and the surgical pitfalls of the treatment. Methods: We analyzed 30 cases of symptomatic aneurysms in the cavernous-petrous portion of the ICA. In all cases, proximal ligation of the ICA was performed with bypass surgery followed by BTO. Results: In 21 patients who could tolerate BTO, we performed a low-flow bypass. In nine patients who could not tolerate BTO, we performed a high-flow bypass. In four patients with ECA-ICA collateral pathways distal to the ligation site, we performed endovascular parent artery occlusion using detachable coils. In four patients without endovascular parent artery occlusion, we experienced recanalization of the aneurysm. Conclusion: Based on our experience and in view of the late recanalization of aneurysms that have an ECA-ICA collateral pathway, we recommend that intraoperative angiography should be performed to detect the ECA-ICA collateral pathway in proximal ligation of the ICA.