Intracavernous Carotid Aneurysm Research Articles

Covered Stents to Treat Partial Recanalization of Onyx-Occluded Giant Intracavernous Carotid Aneurysm

To present the application of a covered stent for the management of a left internal carotid artery (ICA) aneurysm that had recanalized following embolization with Onyx. A 54-year-old man had a giant intracavernous aneurysm of the left ICA successfully occluded with Onyx. Recurrence of symptoms 5 months later prompted control angiography, which showed partial recanalization of the aneurysm. The aneurysm neck was successfully sealed by placing 2 polytetrafluoroethylene-covered stents across it. Control angiography performed at 12 months after stent placement showed no stenosis or signs of recanalization of the aneurysm. Recanalization of giant intracavernous carotid aneurysms post-Onyx treatment may be safely treated with placement of covered stents across the aneurysm neck.

Endovascular Treatment of a Giant Intracranial Aneurysm with a Stent-Graft

This report describes a giant intracavernous carotid aneurysm successfully treated by the placement of a single covered stent. A 40-year-old woman was admitted with a progressive diplopia in relation with palsy of the IV and VI cranial nerves. Magnetic resonance imaging revealed an intracavernous giant aneurysm located at the bifurcation between the origin of a trigeminal artery and the intracavernous portion of the right internal carotid artery. A covered stent was successfully placed, and complete exclusion of the aneurysm was confirmed at 11-month follow-up angiography. The use of covered stents in intracranial vascular structures can now be a feasible way of treating selected cases of wide-necked intracranial aneurysms.

Treatment of carotid cavernous fistula secondary to rupture of a giant intracavernous carotid aneurysm. Transarterial coiling of aneurysm and carotid compression. A case report.

Carotid cavernous fistula secondary to ruptured giant intracavernous aneurysm of the internal carotid artery is rare.We report a case of direct carotid cavernous fistula secondary to rupture of a giant intracavernous ICA aneurysm. The presence of mirror or twin aneurysms of bilateral ophthalmic arteries raises therapeutic challenge. Coiling of the intracavernous aneurysm could partially occlude the fistula. Complete closure of the fistula was facilitated by secondary carotid compression.

Spontaneous thrombosis of a giant internal carotid aneurysm in a patient who presented with hypopituitarism

This case report describes a 66-year-old woman who initially presented with features of hypopituitarism secondary to a giant intra-cavernous internal carotid aneurysm. She represented a year later with features suggestive of a subarachnoid haemorrhage, but repeat CT showed no change from the one performed previously. A repeat angiogram, however, showed complete spontaneous thrombosis of the aneurysm including the parent artery.

Spontaneous thrombosis of a giant internal carotid aneurysm in a patient who presented with hypopituitarism

This case report describes a 66-year-old woman who initially presented with features of hypopituitarism secondary to a giant intra-cavernous internal carotid aneurysm. She represented a year later with features suggestive of a subarachnoid haemorrhage, but repeat CT showed no change from the one performed previously. A repeat angiogram, however, showed complete spontaneous thrombosis of the aneurysm including the parent artery.

Carotid cavernous aneurysm in an HIV-positive patient

An intracavernous carotid aneurysm in an HIV-positive patient with tuberculous meningitis is presented. HIV-associated intracranial aneurysms are rarely detected in adults, unlike children. The aetiology is postulated.

Intracavernous carotid artery aneurysms: The possible importance of angiographic dural waisting. A case report

Cavernous carotid aneurysms are generally benign entities. Certain indications exist for their treatment, however, including transient ischemic events, subarachnoid hemorrhage or risk of subarachnoid hemorrhage, epistaxis or its risk, ophthalmoplegia, pain, and progressive visual loss. We feel certain angiographic features may indicate a greater likelihood that cavernous carotid aneurysms extend into the subarachnoid space, thus making their rupture a life-threatening event. A case report of an intracavernous carotid aneurysm, which at surgery extended into the subarachnoid space, is described. In this particular case, deformation of the aneurysm (waisting) as seen at angiography was in retrospect an indication that the cavernous carotid aneurysm extended into the subarachnoid space, either through the dural ring or through the eroded dural roof of the cavernous sinus. This finding was verified at surgery when the lesion was explored and trapped. Angiographic waisting of a cavernous carotid aneurysm may indicate that the aneurysm extends into the subarachnoid space. Such extension means that rupture would be a life-threatening event. While deformation of the aneurysm may be secondary to compression against the optic nerve or anterior clinoid process with an intact layer of dura overlying the aneurysm, the neurosurgeon confronted with such findings should analyze such lesions carefully and consider surgical exploration.

‘De novo’ aneurysm formation: report of two cases

We report 2 cases of ‘de novo’ aneurysm formation in a vessel which appeared to be normal at a previous angiography. The first patient developed an anterior communicating artery aneurysm nine years after occlusion of the right internal carotid artery by Gianturco coils for the treatment of a giant intracavernous carotid aneurysm. In the second case a ‘de novo’ aneurysm of the internal angle A1–A2 segment of the left anterior cerebral artery developed 6 years after successful clipping of another aneyrysm of the same location. De novo formation of an aneurysm in a vessel which was found to be normal in a previous angiographic study, may occur as result of hemodynamic changes, such as after internal carotid occlusion or in presence of an arteriovenous malformation or variations of the circle of Willis. However, definite hemodynamic changes may also be absent. We conclude that patients operated on for aneurysm clipping must be periodically explored by magnetic resonance angiography to evaluate the possibility of de novo appearance of another aneurysm.

Epistaxis from nontraumatic intracavernous carotid aneurysm: Endovascular treatment with detachable coils and electrothrombosis

Epistaxis from nontraumatic intracavernous carotid aneurysm: Endovascular treatment with detachable coils and electrothrombosis

Multiple Intracranial Aneurysms in a Defined Population

Multiple intracranial aneurysms (MIA) have been detected in up to one-third of patients with cerebral aneurysms. Three main external factors influence these figures as follows: the quality of angiographies, the quantity of vessels studied, and referral policy. In a 1-year prospective study, we determined the incidence of MIA in a defined catchment area in East Finland by investigating all of the patients with intracranial aneurysms with panangiography. In 114 unselected patients, a total of 170 intracranial aneurysms were detected, and, of these, 39 (34%) harbored MIA. In contrast to most other reports, there was a male predominance in patients with MIA, and half of these men had hypertension. Intracavernous carotid and pericallosal aneurysms were more frequent in patients with MIA. The number of asymptomatic vertebrobasilar aneurysms was extremely low, and most of the nonruptured aneurysms were found in bilateral carotid angiograms. In spite of the active search, the proportion of vertebrobasilar aneurysms remained at 6%. Although our surgical policy was most active, one-third of the asymptomatic aneurysms remained untreated, mainly because of the poor condition of the patient.

TRAUMATIC GIANT ANEURYSM OF THE INTRACAVERNOUS INTERNAL CAROTID ARTERY CAUSING FATAL EPISTAXIS

A patient with a giant intracavernous carotid aneurysm usually has symptoms and signs of a space-occupying lesion, producing one of a variety of types of cavernous sinus syndromes. Epistaxis is an unusual feature in these patients. A patient who noted the onset of repeated arterial epistaxis 2 years after a severe head injury was found to have a traumatic aneurysm of the cavernous portion of internal carotid artery. After angiography, he suddenly developed profuse, pulsatile, arterial epistaxis and had a cardiopulmonary arrest. This case and a review of previously reported cases emphasize the importance of early cerebral angiography in patients with posttraumatic recurrent epistaxis.

An unusual cause of epistaxis: non-traumatic intracavernous carotid aneurysm. A case report with 12 year follow-up and review of the literature

Intracavernous carotid aneurysms are uncommon. We report the natural history and radiological appearances of a giant, non-traumatic, intracavernous carotid aneurysm which extended through the skull base to the anterior nares and caused epistaxis. The magnetic resonance imaging appearances of such an aneurysm have not been previously described. The importance of correct diagnosis is discussed.

Intracavernous carotid aneurysm as a rare case of isolated sixth nerve palsy in an eight-year-old child

Cerebral aneurysms are rare in childhood. When occurring they usually present with subarachnoid hemorrhage, but may present as a mass lesion with seizures, or as an incidental finding. An isolated sixth nerve palsy as a presenting sign is even more unusual. The authors describe a case of an acquired sixth nerve palsy in an eight-year-old girl due to a fusiform aneurysm of the intracavernous portion of the internal carotid artery. The clinical problem in this child is complex and involves the management philosophy of dealing with the aneurysm itself as well as that of the abduction deficit which has produced a cosmetically and functionally unacceptable head turn to the ipsilateral side.

Sudden Appearance of a Mycotic Aneurysm of the Intracavernous Carotid Artery after Symptoms Resembling Cluster Headache: Case Report

Abstract Acute cavernous sinus syndrome developed in a 44-year-old man after he had experienced symptoms resembling cluster headache for 3 weeks. The cause was determined to be the sudden appearance of a large saccular aneurysm of the intracavernous portion of the left carotid artery secondary to an acute inflammation of the left cavernous sinus. The absence of this aneurysm before the onset of the ophthalmoplegia was confirmed by a computed tomographic scan and angiogram performed only 1 week earlier. The patient was treated with antibiotics in combination with a short regimen of steroids, which resulted in a slowly developing thrombosis of the aneurysm, although the cavernous sinus syndrome remained. This case suggests several important aspects regarding the pathogenesis of mycotic intracavernous carotid aneurysms, the mechanism of an acute manifestation of the cavernous sinus syndrome by an intracavernous carotid aneurysm, and the relation of the intracavernous portion of the carotid artery to cluster headache. (Neurosurgery 29:594-599, 1991)

Sudden appearance of a mycotic aneurysm of the intracavernous carotid artery after symptoms resembling cluster headache

Acute cavernous sinus syndrome developed in a 44-year-old man after he had experienced symptoms resembling cluster headache for 3 weeks. The cause was determined to be the sudden appearance of a large saccular aneurysm of the intracavernous portion of the left carotid artery secondary to an acute inflammation of the left cavernous sinus. The absence of this aneurysm before the onset of the ophthalmoplegia was confirmed by a computed tomographic scan and angiogram performed only 1 week earlier. The patient was treated with antibiotics in combination with a short regimen of steroids, which resulted in a slowly developing thrombosis of the aneurysm, although the cavernous sinus syndrome remained. This case suggests several important aspects regarding the pathogenesis of mycotic intracavernous carotid aneurysms, the mechanism of an acute manifestation of the cavernous sinus syndrome by an intracavernous carotid aneurysm, and the relation of the intracavernous portion of the carotid artery to cluster headache.

大量の鼻出血を繰り返した両側非外傷性内頚動脈りゅうの症例

A case of bilateral nontraumatic internal carotid aneurysms presenting with recurrent massive epistaxis was reported. A 37-year-old female complaining of massive epistaxis from the left nostril was admitted to our hospital. After admission, she experienced recurrent massive epistaxis, but had no cranial nerve palsies. Carotid angiography demonstrated an aneurysm of the cavernous portion of the left internal carotid artery partially protruding into the sphenoid sinus. Neck clipping of the aneurysm was unsuccessful, therefore the left internal carotid ligation in the neck was performed with a Selverstone clamp. After the ligation, no rebleeding and neurological deficits occurred. Postoperative carotid angiography showed an aneurysm of the right internal carotid artery at the same site. The carotid angiography of 3 months later and 1 year and 3 months later revealed that the left aneurysm decreased in size and the right one remained unchanged. Twenty-one cases including ours that presented nontraumatic internal carotid aneurysm of the cavernous portion were reviewed. Twelve cases had no cranial nerve palsies, and 7 cases including ours had no other symptoms than massive epistaxis. Because massiveness of epistaxis from an internal carotid aneurysm often threatens one's life, diagnosis should be made by carotid angiography as soon as possible. There are several surgical procedures for such aneurysms. Clipping is the ideal method which can interrupt the blood flow to the aneurysm completely, but it is very difficult to be performed anatomically. Carotid ligation in the neck with little surgical invasion was an excellent method in 7 cases without rebleeding and neurological deficits. Bilateral intracavernous internal carotid aneurysms were found in our case and another case.(ABSTRACT TRUNCATED AT 250 WORDS)

非外傷性動脈瘤による鼻出血例と鼻出血統計

A case of massive epistaxis due to internal carotid aneurysm is reported. A 46-yearold female presented with the chief complaint of right epistaxis which had recurred during the past 9 years. The source of bleeding was not determined by routine ENT examination, but the diagnosis of epistaxis due to intracavernous carotid aneurysm was confirmed with the aid of carotid angiograghy. The internal carotid artery was ligatured. Recovery was uneventful, without further epistaxis.We also performed statistical analysis of clinical feature of 327 out-patients and 39 hospitalized patients with epistaxis. The age distribution of the out-patients was negatively skewed to the under 21 age group. The monthly distribution of out-patients showed an increase in frequency in the winter season in those over 60, and in the spring and summer seasons in those under 10. Hospitalized patients showed increases in January, June, and October. Patients over 30 tended to have systematic diseases and to suffer from severe epistaxis requiring hospitalization.

Intracavernous carotid aneurysm — An unusual cause of isolated abducens nerve palsy

We discuss the case of a 59-year-old woman who presented to the emergency department with complaints of diplopia for five days. Physical examination disclosed an isolated complete right abducens nerve palsy. Angiography revealed a giant aneurysm from the postcavernous portion of the right internal carotid artery. This case illustrates an unusual etiology of a unilateral abducens nerve palsy.

Right Aortic Arch With Isolation of the Left Subclavian Artery: Case Report and Review of the Literature

Of the right aortic arch anomalies, a right arch with isolation of the left subclavian artery is the least common. Herein we describe a 52-year-old woman in whom this anomaly was discovered during cerebral angiography for evaluation of a giant symptomatic intracavernous carotid aneurysm. Isolation of the left subclavian artery may be suggested in a patient with a right arch in whom the blood pressure or pulse in the left upper extremity is diminished. Although the isolated left subclavian artery produces the hemodynamic alterations of a subclavian steal, review of the 39 cases reported in the literature revealed only 5 patients with symptoms suggestive of vertebrobasilar insufficiency and 5 patients with weakness of the left upper extremity. Although the patient we describe had no known heart disease, congenital heart disease was present in 23 of the 39 reported cases (59%), tetralogy of Fallot occurring most frequently.

Bilateral Nontraumatic Intracavernous Internal Carotid Aneurysms presenting with Massive Epistaxis

A 68-year-old woman who suddenly developed severe, recurrent epistaxis was found to have bilateral, nontraumatic intracavernous aneurysms. On the right side, a giant aneurysm protruded medially, enlarging the sella turcica. Following emergency ligation of the cervical internal carotid artery under local anesthesia, the bleeding stopped. Subsequently, a right superficial temporal to middle cerebral artery anastomosis was created and the aneurysm was trapped at the C3 portion proximal to the ophthalmic artery. There have been only eight other reports of ruptured nontraumatic intracavernous aneurysms presenting with massive epistaxis. These cases are reviewed and compared with similar cases in which the aneurysms were traumatic in origin. Diagnostic procedures are also discussed.