Tratamento endovascular das lesões vasculares carótido-cavernosas

Objective: : to evaluate the endovascular treatment of vascular lesions of the cavernous segment of the internal carotidartery (ICA) performed at our institution. Methods: : we conducted a descriptive, retrospective and prospective study of patients with aneurysms of the cavernous portion of the ICA or with direct carotid-cavernous fistulas (dCCF) undergoing endovascular treatment. Results: : we included 26 patients with intracavernous aneurysms and ten with dCCF. All aneurysms were treated with ICA occlusion. Those with dCCF were treated with occlusion in seven cases and with selective fistula occlusion in the remaining three. There was improvement of pain and ocular proptosis in all patients with dCCF. In patients with intracavernous aneurysms, the incidence of retro-orbital pain fell from 84.6% to 30.8% after treatment. The endovascular treatment decreased the dysfunction of affected cranial nerves in both groups, especially the oculomotor one. Conclusion: : the endovascular treatment significantly improved the symptoms in the patients studied, especially those related to pain and oculomotor nerve dysfunction. Objetivo: : avaliar o tratamento endovascular de lesoes vasculares da arteria carotida interna (ACI), segmento cavernoso, realizado na Santa Casa de Sao Paulo. Metodos: : estudo descritivo, retrospectivo e prospectivo, de pacientes com aneurisma da porcao cavernosa da ACI ou com fistulas carotido-cavernosas diretas (FCCd) submetidos a tratamento endovascular. Resultados: : foram incluidos 26 pacientes com aneurismas intracavernosos e dez com FCCd. Todos os aneurismas foram tratados com oclusao da ACI. Os com FCCd foram tratados com oclusao, em sete casos, e com oclusao seletiva da fistula nos outros tres. Houve melhora da dor e proptose ocular em todos os pacientes com FCCd. Nos pacientes com aneurisma intracavernoso, a incidencia de dor retro-orbitaria caiu de 84,6% para 30,8% apos o tratamento. Apos o tratamento endovascular houve uma melhora importante da disfuncao de nervos cranianos afetados em ambos os grupos, sobretudo no nervo oculomotor. Conclusao: : o tratamento endovascular trouxe melhora para os pacientes deste estudo, especialmente nos criterios dor e acometimento do nervo oculomotor.