Giant Intracavernous Carotid Artery Aneurysm Research Articles

Cavernous Carotid Aneurysm Presenting as Direct Carotid-Cavernous Fistula with Contralateral Ocular Symptoms: A Rare Case Report

ABSTRACT Carotid-cavernous fistula (CCF) resulting from intracavernous carotid artery aneurysms is uncommon. However, if rupture does occur, it can lead to a CCF, which causes sudden onset of unilateral ophthalmoplegia. In this report, we present a case of a ruptured giant intracavernous carotid artery aneurysm leading to a direct CCF with contralateral ocular features. The aim is to discuss the distinctiveness of this case and the most challenging aspects of identifying similar cases. A woman in her sixties developed a sudden direct CCF, resulting in proptosis in the opposite eye. Magnetic resonance angiography revealed that the left cavernous sinus (CS) and superior ophthalmic vein were dilated, whereas the right side was unaffected. However, digital subtraction angiography (DSA) revealed a large aneurysm in the right cavernous internal carotid artery (ICA) and a direct connection between the right ICA and CS, with venous drainage exclusively occurring in the opposite direction via the intercavernous sinus. To address the issue, the aneurysm and fistula underwent Coil and Onyx embolisation, successfully closing the fistula and leading to a regression in the orbital symptom. This presents a unique scenario of an unexpected unilateral CCF with contralateral symptoms in a direct CCF, which demands immediate attention. It is crucial to remain alert for CCF and verify the diagnosis through DSA when dealing with such patients to avoid severe outcomes. Prompt identification and intervention can enhance the patient’s chances of a positive outcome.

Microsurgical Treatment of a Giant Intracavernous Carotid Artery Aneurysm in a Pediatric Patient. Case Report and Literature Review

Introduction: Intracranial aneurysms in pediatric age represent 4 - 5% of all cases, and 20% are giant (>25mm). The main sites of occurrence are ICA and MCA; about 55% - 72.5% of cases present rupture and secondary SAH with a 10% - 23% mortality. Case Description: We report the case of a previously healthy nine-year-old woman that initiated severe right retroocular pain and holocraneal headache. Her relatives detected paresis of the III, IV, and VI cranial nerves three days later. After evaluation, an MRI showed the presence of a giant aneurysm in the cavernous portion of the internal carotid artery (ICA) with a mass effect. The patient was treated surgically through a high-flow bypass using a radial artery graft and trapping of the aneurysm. The patient had an uneventful postoperative course and was discharged three days after the operation to continue in follow-up at the outpatient clinic. Discussion: The options for treatment are endovascular treatment through flow diverters or stenting and coiling, with the risk of incomplete occlusion or thrombosis. On the other hand, the goal of surgery is the permanent occlusion through the proximal closure of the ICA if a balloon occlusion test shows good collateral circulation or by trapping the aneurysm combined with a high-flow bypass if the collateral circulation is not good or absent. Conclusion: Even when the surgical option was successful in this case, there is no consensus about the best treatment; the selection of the method to use in these aneurysms depends on the center´s experience when confronting this rare entity.

An unusual presentation of “Mirror-Image” bilateral giant carotid cavernous aneurysms: Case report and review of the literature

The almost asymptomatic “mirror-image” bilateral giant intracavernous carotid artery aneurysms are not common and its successful conservative management without further neurological complications is rarely reported. We report a case of a 64-year-old woman, admitted with a rapidly progressive headache, with no other signs or symptoms associated. The Head CT-Scan shows bilateral parasellar round hyperdense lesions and the Magnetic resonance angiography discloses bilateral giant intracavernous carotid artery aneurysms in detail. The clinical presentation of these types of lesions depends on their mass effect on the surrounding neurovascular structures. So, possibly no mass effect on any structure, then no obvious expected symptoms. A patient with these conditions and without neurological deficit should not be rushed to surgery or endovascular treatment.

Delayed Branch Retinal Artery Occlusion and Partial Oculomotor Nerve Palsy Following Coiling of a Giant Intracavernous Carotid Artery Aneurysm

Delayed Branch Retinal Artery Occlusion and Partial Oculomotor Nerve Palsy Following Coiling of a Giant Intracavernous Carotid Artery Aneurysm

Revascularization and Parent Artery Occlusion for Giant Internal Carotid Artery Aneurysms in the Intracavernous Portion Using Intraoperative Monitoring of Cerebral Hemodynamics

Therapeutic parent artery occlusion with or without revascularization is a useful surgical technique for the management of a giant aneurysm located in the intracavernous portion of the internal carotid artery (ICA). The purpose of the present study was to determine whether intraoperative cortical blood flow (CoBF) monitoring during surgical parent artery occlusion could identify patients who required bypass with a saphenous vein graft (high flow bypass). Eleven patients with a giant aneurysm located in the intracavernous portion of the ICA underwent superficial temporal artery-middle cerebral artery bypass. CoBF was monitored intraoperatively in all patients using a thermal diffusion flow probe. The lowest CoBF during test occlusion of the ICA under functioning superficial temporal artery-middle cerebral artery bypass was determined, and the ratio of the value to the CoBF immediately before test occlusion of the ICA was calculated in the frontal and temporal lobes. When the CoBF ratio in the frontal or temporal lobe was less than 0.9, high flow bypass grafting was elected. Of the eleven patients undergoing superficial temporal artery-middle cerebral artery bypass, five patients underwent concomitant high flow bypass grafting. Postoperative cerebral ischemic events did not occur in any patient over a follow-up period ranging from 3 to 60 months. Postoperative cerebral angiography showed resolution of the aneurysm and patency of the bypass in all patients. Intraoperative CoBF monitoring using a thermal diffusion flow probe during surgical parent artery occlusion for giant intracavernous carotid artery aneurysms can identify patients who require concomitant high flow bypass grafting.

Raeder's syndrome after embolization of a giant intracavernous carotid artery aneurysm: pathophysiological considerations

We present the case of a 47 years old woman submitted to an endovascular trapping of a left cavernous internal carotid artery aneurysm, in which the distal balloon was inflated, as usually done, within the cavernous segment of the internal carotid artery, different from the proximal one which was inflated inside the carotid canal due to technical problems. Consequently, a clinical picture of Raeder's paratrigeminal neuralgia took place. This is the first case report in the literature with theses characteristics. A review of the anatomic pathways and further considerations about the possible pathophysiological mechanisms involved are presented.

Microsurgical and Endovascular Treatment of Giant Intracavernous Aneurysms

Treatment of giant intracavernous carotid artery aneurysms (ICCA), rare but formidable challenging lesions, requires scrupulous review of the clinical and radiographic studies and involves several different or successive surgical approaches. To attain complete permanent exclusion of the ICCAs from the circulation while preserving the parent carotids, microsurgical or endovascular techniques should be employed. Three kinds of surgical approaches can be addressed: (1) direct surgical aneurysm obliteration with parent artery preservation, (2) indirect obliteration using parent artery sacrifice, and (3) indirect aneurysm obliteration followed by extracranial-to-intracranial bypass or interposition grafts. In most instances, however, endovascular intervention with or without vessel reconstruction is now the initial treatment. When one considers parent carotid occlusion, balloon test occlusion should be performed irrespective of surgical options.

Mechanism of acute deterioration of the neurological status following rapid and massive intraluminal thrombosis in case of a giant intracavernous carotid artery aneurysm: Demonstration by mr imaging

A case is reported of a thrombosed giant aneurysm of the intracavernous carotid artery. Transient neurological deterioration was attributable to the acute swelling of the aneurysmal mass after rapid and massive intraluminal thrombosis. Characteristics on the magnetic resonance imaging of this case are reported and discussed.