Surgical Treatment of Intracavernous Vascular Lesions: Indications and Results

摘要

Two major intracavernous vascular lesions are encountered in the practice of neurologic surgery: carotid cavernous fistulas and cavernous carotid aneurysms. The pioneering work of Parkinson published in the 1960s provided the necessary anatomic information to allow direct surgical approaches to the cavernous sinus and hence to these lesions. With the advent of current endovascular techniques, the indications for surgery in the cavernous sinus have decreased but not vanished. Surgery for carotid cavernous fistulas consists of a frontotemporal craniotomy and intradural approach to the region of cavernous sinus. An incision is made in Parkinson's triangle, and the sinus is packed. Intraoperative angiography is used as a guide to ensure obliteration of the fistula while patency of the carotid artery is maintained. Cavernous carotid aneurysms are treated surgically using a combination of aneurysm trapping and vascular bypass through a modified Dolenc approach. Despite the success of endovascular techniques, neurologic surgeons must maintain the necessary microsurgical skills to treat lesions refractory to obliteration in the angiography suite.