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Natural History of Cavernous Carotid Artery Aneurysms: A Systematic Review and Meta-Analysis Publisher Pubmed



Shahbandi A1 ; Halpin BS2, 3, 4 ; Turcotte EL3, 4, 5 ; Krishna C2 ; Di Nome MA2, 6 ; Bendok BR2, 3, 4, 7, 8
Authors
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Authors Affiliations
  1. 1. School of Medicine, Tehran University of Medical Science, Tehran, Iran
  2. 2. Department of Neurologic Surgery, Mayo Clinic, Phoenix, AZ, United States
  3. 3. Precision Neuro-therapeutics Innovation Laboratory, Mayo Clinic, Phoenix, AZ, United States
  4. 4. Neurosurgery Simulation and Innovation Laboratory, Mayo Clinic, Phoenix, AZ, United States
  5. 5. Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, AZ, United States
  6. 6. Department of Ophthalmology, Mayo Clinic, Scottsdale, AZ, United States
  7. 7. Department of Otolaryngology, Mayo Clinic, Phoenix, AZ, United States
  8. 8. Department of Radiology, Mayo Clinic, Phoenix, AZ, United States

Source: World Neurosurgery Published:2024


Abstract

Background: Cavernous carotid artery aneurysms (CCAAs) represent a common condition seen in clinical practice with significant practice variability. The aim of this systematic review and meta-analysis was to aggregate current evidence on the natural history of CCAAs. Methods: MEDLINE/PubMed, EMBASE, and Cochrane Library were queried from inception until December 2023. The primary outcome of this study was CCAA-related mortality. The secondary outcomes of this study were aneurysm growth, intracranial ischemic and hemorrhagic events, improved non-cerebrovascular symptoms, and new or worsened non-cerebrovascular symptoms during follow-up. Results: Ten studies met our inclusion criteria, involving 835 patients and 975 CCAAs. CCAA-related mortality had an incidence rate of 0.28 (95% CI 0.12–0.64) per 100 person-years (PYs) of follow-up. The incidence rate of CCAA growth was 2.91 (1.05–8.07) per 100 PYs of follow-up. The incidence rate of CCAA-related intracranial ischemic events was 0.4 (0.16–1.01) per 100 PYs of follow-up. The incidence rate of CCAA-related intracranial hemorrhagic events was 0.54 (0.33–0.87) per 100 PYs of follow-up. The incidence rate of improved non-cerebrovascular symptoms was 2.51 (1.18–5.33) per 100 PYs of follow-up. The incidence rate of new or worsened non-cerebrovascular symptoms was 3.41 (2.03–5.73) per 100 PYs of follow-up. Conclusions: CCAAs are typically benign lesions with a low risk of rupture and life-threatening complications. CCAAs tend to follow an indolent course regarding non-cerebrovascular outcomes, and new or worsening symptoms are infrequent during the clinical course. However, spontaneous resolution of non-cerebrovascular symptoms and cranial nerve deficits at presentation is uncommon. © 2024
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