title: Treatment of cavernous sinus aneurysms with flow diversion: results in 44 patients.
abstract: OBJECTIVE
  Aneurysms of the cavernous segment of the ICA are difficult to treat with standard endovascular techniques, and ICA sacrifice achieves a high rate of occlusion but carries an elevated level of surgical complications and risk of de novo aneurysm formation. We report rates of occlusion and treatment-related data in 44 patients with cavernous sinus aneurysms treated with flow diversion.
  
  
  METHODS
  Patients with cavernous segment aneurysms treated with flow diversion were selected from a prospectively maintained data base of patients from 2009 to the present. Demographic information, treatment indications, number/type of flow diverters placed, outcome, complications (technical or clinical), and clinical/imaging follow-up data were analyzed.
  
  
  RESULTS
  We identified 44 patients (37 females, 7 males) who had a flow diverter placed for treatment of a cavernous ICA aneurysm (mean age, 57.2; mean aneurysm size, 20.9 mm). The mean number of devices placed per patient was 2.2. At final angiographic follow-up (mean, 10.9 months), 71% had complete occlusion, and of those with incomplete occlusion, 40% had minimal remnants (<3 mm). In symptomatic patients, complete resolution or significant improvement in symptoms was noted in 90% at follow-up. Technical complications (which included, among others, vessel perforation in 4 patients, groin hematoma in 2, and asymptomatic carotid occlusion in 1) occurred in approximately 36% of patients but did not result in any clinical sequelae immediately or at follow-up.
  
  
  CONCLUSIONS
  Our series of flow-diversion treatments achieved markedly greater rates of complete occlusion than coiling, with a safety profile that compares favorably with that of carotid sacrifice.
authors.affiliation: From the Departments of Neurosurgery (R.C.P.).
authors.forename: R C
authors.initials: RC
authors.lastname: Puffer
authors.affiliation: Division of Neuroradiology (M.P., L.V., L.Q., E.B.), Ospedale Niguarda, Milano, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Piano
authors.affiliation: Radiology (G.L., D.F.K., H.J.C.), Mayo Clinic, Rochester, Minnesota lanzino.giuseppe@mayo.edu.
authors.forename: G
authors.initials: G
authors.lastname: Lanzino
authors.affiliation: Division of Neuroradiology (M.P., L.V., L.Q., E.B.), Ospedale Niguarda, Milano, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Valvassori
authors.affiliation: Radiology (G.L., D.F.K., H.J.C.), Mayo Clinic, Rochester, Minnesota.
authors.forename: D F
authors.initials: DF
authors.lastname: Kallmes
authors.affiliation: Division of Neuroradiology (M.P., L.V., L.Q., E.B.), Ospedale Niguarda, Milano, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Quilici
authors.affiliation: Radiology (G.L., D.F.K., H.J.C.), Mayo Clinic, Rochester, Minnesota.
authors.forename: H J
authors.initials: HJ
authors.lastname: Cloft
authors.affiliation: Division of Neuroradiology (M.P., L.V., L.Q., E.B.), Ospedale Niguarda, Milano, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Boccardi
mesh_terms: D001807:Blood Vessel Prosthesis; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery*; D002426:Cavernous Sinus / Q000000981:diagnostic imaging / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome