This review discusses management of aneurysms arising from the internal carotid artery from the entrance into the cavernous sinus until just before the take off of the posterior communicating artery. Whilst paraclinoid aneurysms do not tend to have ENT presentations, cavernous ones may rarely present with epistaxis, and retro-orbital pain. Focusing on cavernous aneurysms, treatment depends upon whether they are ruptured / unruptured, and if they are symptomatic or not. Endovascular management is preferred over open surgical intervention because of the latter’s high morbidity and mortality. For unruptured, asymptomatic aneurysms (i.e. detected incidentally), treatment is not recommended if <13mm; and for those >13mm, the decision is made on a case-by-case basis. For the unruptured, symptomatic, and ruptured aneurysms, generally coil embolisation is well tolerated. Flow diversion is a newer technology and complements coiling well with higher occlusion rates.

Endovascular management of cavernous and paraclinoid aneurysms.
Brown B, Hanel RA.
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Gentle Wong

Guy's and St Thomas' Hospitals, UK.

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