Matricidal cavernous aneurysms: A multicenter case series

Mallory R. Dacus, Chris Nickele, Babu G. Welch, Vin Shen Ban, Andrew J. Ringer, Louis J. Kim, Michael R. Levitt, Giuseppe Lanzino, Peter Kan, Adam Arthur

Research output: Contribution to journalArticle

Abstract

Background Cavernous carotid artery aneurysms (CCAs) represent a unique subset of intracranial aneurysms due to their distinct natural history and the anatomy of the cavernous sinus. Enlarging CCAs can cause elastic compression of the parent internal carotid artery (ICA). We suggest defining aneurysms that cause luminal stenosis of their parent vessels as â € matricidal aneurysms.' Though many patients are asymptomatic, presenting symptoms of CCAs include ophthalmoplegia with resulting diplopia, vision changes, pain, ptosis, facial numbness, and cavernous-carotid fistula. Less commonly, patients with CCAs can present with epistaxis, subarachnoid hemorrhage, and-in cases of matricidal aneurysms-ischemia due to stenosis. The proper management of stenosis caused by a matricidal CCA is not well established and may not be intuitive. Methods We present a multicenter retrospective case series of patients with matricidal CCAs. Results Forty patients with matricidal aneurysms presented with both asymptomatic and symptomatic stenosis. These patients were either treated with conservative medical management, coiling, flow diversion, or endovascular sacrifice of the parent artery. Planned treatment modalities were not executed in 11 cases (28% treatment failure rate). Presenting symptoms, patient outcomes, and follow-up data are presented for all cases. Conclusion Matricidal aneurysms require careful consideration and planning. The restricted anatomy of the cavernous sinus can make successful execution of endovascular interventions more difficult. Direct elastic compression of the parent artery does not respond to angioplasty and stenting in the same way atherosclerotic stenosis does. Because of this, planning for the possibility of parent vessel sacrifice is important.

Original languageEnglish (US)
Pages (from-to)584-590
Number of pages7
JournalJournal of neurointerventional surgery
Volume11
Issue number6
DOIs
StatePublished - Jun 1 2019

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Aneurysm
Carotid Arteries
Pathologic Constriction
Cavernous Sinus
Anatomy
Arteries
Ophthalmoplegia
Facial Pain
Epistaxis
Diplopia
Hypesthesia
Intracranial Aneurysm
Internal Carotid Artery
Subarachnoid Hemorrhage
Natural History
Treatment Failure
Angioplasty
Fistula
Ischemia

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Dacus, M. R., Nickele, C., Welch, B. G., Ban, V. S., Ringer, A. J., Kim, L. J., ... Arthur, A. (2019). Matricidal cavernous aneurysms: A multicenter case series. Journal of neurointerventional surgery, 11(6), 584-590. https://doi.org/10.1136/neurintsurg-2018-014562

Matricidal cavernous aneurysms : A multicenter case series. / Dacus, Mallory R.; Nickele, Chris; Welch, Babu G.; Ban, Vin Shen; Ringer, Andrew J.; Kim, Louis J.; Levitt, Michael R.; Lanzino, Giuseppe; Kan, Peter; Arthur, Adam.

In: Journal of neurointerventional surgery, Vol. 11, No. 6, 01.06.2019, p. 584-590.

Research output: Contribution to journalArticle

Dacus, MR, Nickele, C, Welch, BG, Ban, VS, Ringer, AJ, Kim, LJ, Levitt, MR, Lanzino, G, Kan, P & Arthur, A 2019, 'Matricidal cavernous aneurysms: A multicenter case series', Journal of neurointerventional surgery, vol. 11, no. 6, pp. 584-590. https://doi.org/10.1136/neurintsurg-2018-014562
Dacus, Mallory R. ; Nickele, Chris ; Welch, Babu G. ; Ban, Vin Shen ; Ringer, Andrew J. ; Kim, Louis J. ; Levitt, Michael R. ; Lanzino, Giuseppe ; Kan, Peter ; Arthur, Adam. / Matricidal cavernous aneurysms : A multicenter case series. In: Journal of neurointerventional surgery. 2019 ; Vol. 11, No. 6. pp. 584-590.
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abstract = "Background Cavernous carotid artery aneurysms (CCAs) represent a unique subset of intracranial aneurysms due to their distinct natural history and the anatomy of the cavernous sinus. Enlarging CCAs can cause elastic compression of the parent internal carotid artery (ICA). We suggest defining aneurysms that cause luminal stenosis of their parent vessels as {\^a} € matricidal aneurysms.' Though many patients are asymptomatic, presenting symptoms of CCAs include ophthalmoplegia with resulting diplopia, vision changes, pain, ptosis, facial numbness, and cavernous-carotid fistula. Less commonly, patients with CCAs can present with epistaxis, subarachnoid hemorrhage, and-in cases of matricidal aneurysms-ischemia due to stenosis. The proper management of stenosis caused by a matricidal CCA is not well established and may not be intuitive. Methods We present a multicenter retrospective case series of patients with matricidal CCAs. Results Forty patients with matricidal aneurysms presented with both asymptomatic and symptomatic stenosis. These patients were either treated with conservative medical management, coiling, flow diversion, or endovascular sacrifice of the parent artery. Planned treatment modalities were not executed in 11 cases (28{\%} treatment failure rate). Presenting symptoms, patient outcomes, and follow-up data are presented for all cases. Conclusion Matricidal aneurysms require careful consideration and planning. The restricted anatomy of the cavernous sinus can make successful execution of endovascular interventions more difficult. Direct elastic compression of the parent artery does not respond to angioplasty and stenting in the same way atherosclerotic stenosis does. Because of this, planning for the possibility of parent vessel sacrifice is important.",
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AU - Kim, Louis J.

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N2 - Background Cavernous carotid artery aneurysms (CCAs) represent a unique subset of intracranial aneurysms due to their distinct natural history and the anatomy of the cavernous sinus. Enlarging CCAs can cause elastic compression of the parent internal carotid artery (ICA). We suggest defining aneurysms that cause luminal stenosis of their parent vessels as â € matricidal aneurysms.' Though many patients are asymptomatic, presenting symptoms of CCAs include ophthalmoplegia with resulting diplopia, vision changes, pain, ptosis, facial numbness, and cavernous-carotid fistula. Less commonly, patients with CCAs can present with epistaxis, subarachnoid hemorrhage, and-in cases of matricidal aneurysms-ischemia due to stenosis. The proper management of stenosis caused by a matricidal CCA is not well established and may not be intuitive. Methods We present a multicenter retrospective case series of patients with matricidal CCAs. Results Forty patients with matricidal aneurysms presented with both asymptomatic and symptomatic stenosis. These patients were either treated with conservative medical management, coiling, flow diversion, or endovascular sacrifice of the parent artery. Planned treatment modalities were not executed in 11 cases (28% treatment failure rate). Presenting symptoms, patient outcomes, and follow-up data are presented for all cases. Conclusion Matricidal aneurysms require careful consideration and planning. The restricted anatomy of the cavernous sinus can make successful execution of endovascular interventions more difficult. Direct elastic compression of the parent artery does not respond to angioplasty and stenting in the same way atherosclerotic stenosis does. Because of this, planning for the possibility of parent vessel sacrifice is important.

AB - Background Cavernous carotid artery aneurysms (CCAs) represent a unique subset of intracranial aneurysms due to their distinct natural history and the anatomy of the cavernous sinus. Enlarging CCAs can cause elastic compression of the parent internal carotid artery (ICA). We suggest defining aneurysms that cause luminal stenosis of their parent vessels as â € matricidal aneurysms.' Though many patients are asymptomatic, presenting symptoms of CCAs include ophthalmoplegia with resulting diplopia, vision changes, pain, ptosis, facial numbness, and cavernous-carotid fistula. Less commonly, patients with CCAs can present with epistaxis, subarachnoid hemorrhage, and-in cases of matricidal aneurysms-ischemia due to stenosis. The proper management of stenosis caused by a matricidal CCA is not well established and may not be intuitive. Methods We present a multicenter retrospective case series of patients with matricidal CCAs. Results Forty patients with matricidal aneurysms presented with both asymptomatic and symptomatic stenosis. These patients were either treated with conservative medical management, coiling, flow diversion, or endovascular sacrifice of the parent artery. Planned treatment modalities were not executed in 11 cases (28% treatment failure rate). Presenting symptoms, patient outcomes, and follow-up data are presented for all cases. Conclusion Matricidal aneurysms require careful consideration and planning. The restricted anatomy of the cavernous sinus can make successful execution of endovascular interventions more difficult. Direct elastic compression of the parent artery does not respond to angioplasty and stenting in the same way atherosclerotic stenosis does. Because of this, planning for the possibility of parent vessel sacrifice is important.

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