Endovascular treatment of aneurysms in the cavernous sinus: A systematic review on balloon occlusion of the parent vessel and embolization with coils

• Published in: Stroke (1970) Vol. 33; no. 1; pp. 313 - 318
• Main Authors: VAN DER SCHAAF, Irene C, BRILSTRA, Eva H, BUSKENS, Eric, RINKEL, Gabriël J. E
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 2002
• Subjects: Balloon Occlusion - adverse effects; Balloon Occlusion - methods; Biological and medical sciences; Carotid Artery Diseases - diagnosis; Carotid Artery Diseases - therapy; Cavernous Sinus; Diseases of the nervous system; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - methods; Humans; Intracranial Aneurysm - diagnosis; Intracranial Aneurysm - therapy; Linear Models; Medical sciences; Middle Aged; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Treatment Outcome; Human; Cavernous sinus; Intracranial; Nervous system diseases; Aneurysm; Instrumentation therapy; Cardiovascular disease; Balloon; Endovascular route; Cerebral disorder; Coil; Vascular disease; Case study; Treatment; Ischemia; Central nervous system disease; Complication; Embolization; Cerebrovascular disease
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/hs0102.101479

Balloon occlusion of the parent vessel and endosaccular coiling are both frequently used for treatment of intracavernous aneurysms of the carotid artery. We performed a systematic review of studies reporting on these two treatment modalities to assess the rate of complications, rate of successful aneurysm occlusion, and clinical condition after treatment. We performed a MEDLINE search for studies published between January 1974 and May 1999 and hand-searched recent volumes of 21 journals. Two authors independently extracted data by means of a standardized data extraction form. We found 35 studies reporting on 316 patients. Only 9 of the 35 studies reported on more than 5 patients; in only 9 studies (totaling 85 patients), well-defined outcome measures were used. Twenty-five studies (with 78% of all patients included in the review) reported on balloon occlusion. Complications during or in the first 24 hours after the balloon occlusion occurred in 4 of 247 patients (1.6%; 95% CI, 0.01% to 3.2%) and late ischemic complications in 5 of 148 patients (3.4%; 95% CI, 0.43% to 6.4%). Clinical follow-up was performed in 21 of 25 studies on treatment by means of balloon occlusion (148 [60%] of the 247 patients). None of the 68 patients treated by embolization with coils had a complication (0%; 95% CI, 0% to 4.3%). Of 157 aneurysms treated by balloon occlusion, 153 were completely thrombosed (97.5%; 95% CI, 95% to 100%). After coiling, 52 of 65 aneurysms (80%; 95% CI, 70% to 90%) were occluded by >90%. Many studies included in this review had methodological weaknesses. The available data suggest that both balloon occlusion and endosaccular coiling are reasonably safe and result in occlusion of the aneurysm in the majority of patients. However, long-term outcomes have not yet been reported.