Acta Neurochirurgica

, Volume 159, Issue 9, pp 1693–1698 | Cite as

Bilateral cavernous carotid aneurysms treated by two-stage extracranial-intracranial bypass followed by parent artery occlusion: case report and literature review

  • Yaoling Liu
  • Xiang’en ShiEmail author
  • Fangjun Liu
  • Yuming Sun
  • Hai Qian
  • Ting Lei
Case Report - Vascular


Bilateral cavernous carotid aneurysms (CCAs) are often not amenable to neurosurgical clipping or endovascular coiling. Here, we report the case of a 50-year-old female who presented with a 1-year history of gradual severe headache. Preoperative angiograms revealed bilateral CCAs. Among these findings, the right giant CCA had been trapped after the external carotid artery-saphenous vein-middle cerebral artery (ECA-SV-MCA) bypass 8 years prior. Additionally, the left CCA was again trapped after the internal maxillary artery-radial artery-middle cerebral artery (IMA-RA-MCA) bypass, followed by parent artery occlusion (PAO), because of the enlargement of a 0.4-cm aneurysm to a 1.3-cm aneurysm during the 5th to 8th years following surgery. Postoperative radiologic findings proved that the aneurysms disappeared with good graft patency of the bilateral anastomoses and excellent filling of the bilateral MCA territories. This is the first case of bilateral CCAs treated with two stages of bilateral high-flow extracranial-intracranial (EC-IC) bypass, including an IMA-RA-MCA bypass.


Cavernous carotid aneurysms Extracranial–Intracranial bypass Internal maxillary artery Enlargement Bilateral bypass 



This work was supported by the grant: Beijing Municipal Natural Science Foundation (grant no. 7161005 to Xiang’en Shi) and the Science and Technology Commission Foundation of Beijing (grant no. Z161100000516019 to Xiang’en Shi)

Compliance with Ethical Standards

The patient/next of kin/guardian has consented to submission of this case report to the journal.

Conflicts of interest



  1. 1.
    Ambekar S, Madhugiri V, Sharma M, Cuellar H, Nanda A (2014) Evolution of management strategies for cavernous carotid aneurysms: a review. World Neurosurg 82:1077–1085CrossRefPubMedGoogle Scholar
  2. 2.
    Burns JD, Huston J 3rd, Layton KF, Piepgras DG, Brown RD Jr (2009) Intracranial aneurysm enlargement on serial magnetic resonance angiography: frequency and risk factors. Stroke; J Cereb Circ 40:406–411CrossRefGoogle Scholar
  3. 3.
    Eddleman CS, Hurley MC, Bendok BR, Batjer HH (2009) Cavernous carotid aneurysms: to treat or not to treat? Neurosurg Focus 26, E4CrossRefPubMedGoogle Scholar
  4. 4.
    Field M, Jungreis CA, Chengelis N, Kromer H, Kirby L, Yonas H (2003) Symptomatic cavernous sinus aneurysms: management and outcome after carotid occlusion and selective cerebral revascularization. AJNR Am J Neuroradiol 24:1200–1207PubMedGoogle Scholar
  5. 5.
    Fujimura M, Sato K, Kimura N, Inoue T, Shimizu H, Tominaga T (2014) A case of bilateral giant internal carotid artery aneurysms at the cavernous portion managed by 2-stage extracranial-intracranial bypass with parent artery occlusion: consideration for bypass selection and timing of surgeries. J Stroke Cerebrovasc Dis: Off J Natl Stroke Assoc 23:e393–398CrossRefGoogle Scholar
  6. 6.
    Gobble RM, Hoang H, Jafar J, Adelman M (2012) Extracranial-intracranial bypass: resurrection of a nearly extinct operation. J Vasc Surg 56:1303–1307CrossRefPubMedGoogle Scholar
  7. 7.
    Goldenberg-Cohen N, Curry C, Miller NR, Tamargo RJ, Murphy KP (2004) Long term visual and neurological prognosis in patients with treated and untreated cavernous sinus aneurysms. J Neurol Neurosurg Psychiatry 75:863–867CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Kai Y, Hamada J, Morioka M, Yano S, Mizuno T, Kuroda J, Todaka T, Takeshima H, Kuratsu J (2007) Treatment strategy for giant aneurysms in the cavernous portion of the internal carotid artery. Surg Neurol 67:148–155, discussion 155CrossRefPubMedGoogle Scholar
  9. 9.
    Kupersmith MJ, Stiebel-Kalish H, Huna-Baron R, Setton A, Niimi Y, Langer D, Berenstein A (2002) Cavernous carotid aneurysms rarely cause subarachnoid hemorrhage or major neurologic morbidity. J Stroke Cerebrovasc Dis: Off J Natl Stroke Assoc 11:9–14CrossRefGoogle Scholar
  10. 10.
    Ma Y, Li M, Zhang H, Ling F (2010) A 10-year follow-up of extracranial-intracranial bypass for the treatment of bilateral giant internal carotid artery aneurysms in a patient with fibromuscular dysplasia: case report. Acta Neurochir 152:2191–2195CrossRefPubMedGoogle Scholar
  11. 11.
    Ng WH, Chou N, Lee T (2001) Giant aneurysm treated by bilateral cervical carotid artery to proximal middle cerebral artery bypass and balloon embolisation: a case report. J Clin Neurosci: Off J Neurosurg Soc Aust 8:580–583CrossRefGoogle Scholar
  12. 12.
    Nishino K, Hasegawa H, Ito Y, Fujii Y (2015) Bilateral Cavernous Carotid Aneurysms: The Growth Potential of a Contralateral Aneurysm after Therapeutic Unilateral Internal Carotid Artery Occlusion. J Stroke Cerebrovasc Dis: Off J Natl Stroke Assoc 24:1865–1872CrossRefGoogle Scholar
  13. 13.
    Rehman T, Ali R, Taylor C, Yonas H (2010) Bilateral giant cavernous carotid artery aneurysms in a child with juvenile Paget’s disease. World Neurosurg 73:691–693CrossRefPubMedGoogle Scholar
  14. 14.
    Seltzer J, Hurteau EF (1957) Bilateral symmetrical aneurysms of internal carotid artery within the cavernous sinus; case report. J Neurosurg 14:448–451CrossRefPubMedGoogle Scholar
  15. 15.
    Shi X, Qian H, K CK, Zhang Y, Zhou Z, Sun Y (2011) Bypass of the maxillary to proximal middle cerebral artery or proximal posterior cerebral artery with radial artery graft. Acta neurochirurgica 153:1649–1655; discussion 1655Google Scholar
  16. 16.
    Stiebel-Kalish H, Kalish Y, Bar-On RH, Setton A, Niimi Y, Berenstein A, Kupersmith MJ (2005) Presentation, natural history, and management of carotid cavernous aneurysms. Neurosurgery 57:850–857, discussion 850–857CrossRefPubMedGoogle Scholar
  17. 17.
    Turfe ZA, Brinjikji W, Murad MH, Lanzino G, Cloft HJ, Kallmes DF (2015) Endovascular coiling versus parent artery occlusion for treatment of cavernous carotid aneurysms: a meta-analysis. J Neurointerv Surg 7:250–255CrossRefPubMedGoogle Scholar
  18. 18.
    Uozumi Y, Okamoto S, Araki Y, Izumi T, Matsubara N, Yokoyama K, Sumitomo M, Miyachi S, Wakabayashi T (2015) Treatment of symptomatic bilateral cavernous carotid aneurysms: long-term results of 6 cases. J Stroke Cerebrovasc Dis: Off J Natl Stroke Assoc 24:1013–1018CrossRefGoogle Scholar
  19. 19.
    Welch BG, Batjer HH (2014) Cavernous carotid aneurysms: you can but should you? World Neurosurg 82:996–997CrossRefPubMedGoogle Scholar
  20. 20.
    Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr, Piepgras DG, Forbes GS, Thielen K, Nichols D, O’Fallon WM, Peacock J, Jaeger L, Kassell NF, Kongable-Beckman GL, Torner JC (2003) Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362:103–110CrossRefPubMedGoogle Scholar
  21. 21.
    Zanaty M, Chalouhi N, Starke RM, Barros G, Saigh MP, Schwartz EW, Ajiboye N, Tjoumakaris SI, Hasan D, Rosenwasser RH, Jabbour P (2014) Flow diversion versus conventional treatment for carotid cavernous aneurysms. Stroke; J Cereb Circ 45:2656–2661CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2017

Authors and Affiliations

  • Yaoling Liu
    • 1
    • 2
  • Xiang’en Shi
    • 1
    • 2
    Email author
  • Fangjun Liu
    • 2
  • Yuming Sun
    • 2
  • Hai Qian
    • 2
  • Ting Lei
    • 2
  1. 1.Department of Neurosurgery, Affiliated Fuxing HospitalCapital Medical UniversityBeijingChina
  2. 2.Department of Neurosurgery, Beijing Sanbo Brain HospitalCapital Medical UniversityBeijingChina

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