Clinical presentation, treatment and outcome in 11 patients with ruptured cavernous sinus aneurysms causing CCF

Patient No./ Gender/Age (y)PresentationDiagnosisPrincipal Venous DrainageTest OcclusionTreatmentOutcome; Duration of Follow-up in Months
1/F/77Bilateral exophthalmus and ophthalmoplegia, vision 0.1 bilateral, pulsatile bruitHigh-flow left CCFBilateral superior ophthalmic vein, minor cortical venous drainage−Coiling aneurysm with balloon protection, carotid artery patentComplete recovery; 9 mo
2/F/75Left exophthalmus and ophthalmoplegia, pulsatile bruit, decreased visionIntermediate-flow left CCFLeft superior ophthalmic vein, no cortical venous drainage−Coiling aneurysm ×2Complete recovery; 72 mo
3/F/60Left hemiplegia and aphasia, bilateral exophthalmus and ophthalmoplegia, decreased vision, pulsatile bruitHigh-flow right CCFBilateral superior ophthalmic vein, major cortical venous drainage+Coiling aneurysm with balloon protection, carotid artery patentComplete recovery; 6 mo
4/F/61Bilateral exophthalmus and ophthalmoplegia, decreased vision, pulsatile bruitIntermediate-flow left CCFBilateral superior ophthalmic vein, minor cortical venous drainage+Balloon occlusion aneurysm, later coiling pseudo-aneurysmComplete recovery; 18 mo
5/M/27Left abducens palsy, decreased vision, pulsatile bruitLow-flow left CCFLeft superior ophthalmic vein, left petrosal sinus, no cortical venous drainageNot doneSpontaneous closure, coiling aneurysm ×2Complete recovery; 24 mo
6/F/70Bilateral exophthalmus and ophthalmoplegia, decreased vision, pulsatile bruitHigh-flow left CCFBilateral superior ophthalmic vein, minor cortical venous drainage+Coiling aneurysm with balloon protection, carotid artery patentComplete recovery; 34 mo
7/F/51Right exophthalmus and ophthalmoplegia, pulsatile bruitHigh-flow right CCFRight superior ophthalmic vein, no cortical venous drainage+Coiling aneurysm with balloon protection, carotid artery patentComplete recovery; 28 mo
8/M/58Left exophthalmus, left abducens palsy, pulsatile bruitLow-flow left CCFLeft superior ophthalmic vein, no cortical venous drainage+Spontaneous closure CCF, carotid occlusionRemaining VI palsy; 4 mo
9/F/74Bilateral exophthalmus and ophthalmoplegia, decreased vision, pulsatile bruitIntermediate-flow right CCFBilateral superior ophthalmic vein, minor cortical venous drainage+Coiling aneurysm + carotid arteryRemaining right VI palsy; 7 mo
10/M/65Left exophthalmus and ophthalmoplegia, vision 0 left, pulsatile bruitHigh-flow left CCFLeft superior ophthalmic vein+Coiling aneurysm + carotid arteryEnucleation left eye; 38 mo
11/F/59Pulsatile bruit, left temporal hemorrhage ×2High-flow right CCFMajor cortical venous drainageNot doneNoneDeath

  • Note:—+ indicates tolerance; −, nontolerance.