PDF herunterladen
CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2021; 10(02): 165-168
DOI: 10.1055/s-0040-1718989
Case Report

Rare Clinical Onset of Nontraumatic Intracavernous Aneurysm of the Internal Carotid Artery: A Diagnostic and Therapeutic Challenge

Enzo Emanuelli
1   Unit of Otorhinolaryngology, Department of Neuroscience, University of Padova, Padova, Italy
,
Maria Baldovin
1   Unit of Otorhinolaryngology, Department of Neuroscience, University of Padova, Padova, Italy
,
Claudia Zanotti
1   Unit of Otorhinolaryngology, Department of Neuroscience, University of Padova, Padova, Italy
,
Sara Munari
1   Unit of Otorhinolaryngology, Department of Neuroscience, University of Padova, Padova, Italy
,
Luca Denaro
2   Department of Neuroscience, University of Padova, Padova, Italy
,
Athanasios Saratziotis
3   Department of Otolaryngology, Head and Neck Surgery, University Hospital of Larissa, Larisa, Greece
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

Abstract

While the so-called pseudoaneurysms can result from arterial injury during trans-sphenoidal surgery or after a trauma, spontaneous aneurysms of cavernous–internal carotid artery (CICA) are rare. Symptoms vary and the differential diagnosis with other, more frequent, sellar lesions is difficult. We describe three cases of misdiagnosed CICA spontaneous aneurysm. In two cases the onset was with neuro-ophthalmological manifestations, classifiable as “cavernous sinus syndrome.” The emergency computed tomography scan did not show CICA aneurysm and the diagnosis was made by surgical exploration. The third patient came to our attention with a sudden severe unilateral epistaxis; endonasal surgery revealed also in this case a CICA aneurysm, eroding the wall and protruding into the sphenoidal sinus. When the onset was with a cavernous sinus syndrome, misdiagnosis exposed two patients to potential serious risk of bleeding, while the patient with epistaxis was treated with embolization, using coils and two balloons. Intracavernous nontraumatic aneurysms are both a diagnostic and therapeutic challenge, because of their heterogeneous onset and risk of rupture, potentially lethal. Intracavernous aneurysms can be managed with radiological follow-up, if asymptomatic or clinically stable, or can be surgically treated with endovascular or microsurgical techniques.

Keywords

intracavernous aneurysms - nontraumatic aneurysms - cavernous sinus syndrome


Publikationsverlauf

Artikel online veröffentlicht:
19. Dezember 2020

© 2020. Neurological Surgeons’ Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Vijaywargiya M, Deopujari R, Athavale SA. Anatomical study of petrous and cavernous parts of internal carotid artery. Anat Cell Biol 2017; 50 (03) 163-170
    CrossrefPubMedSuche in Google Scholar
  • 2 Fujii K, Chambers SM, Rhoton AL Jr. Neurovascular relationships of the sphenoid sinus. A microsurgical study. J Neurosurg 1979; 50 (01) 31-39
    CrossrefPubMedSuche in Google Scholar
  • 3 Stiebel-Kalish H, Kalish Y, Bar-On RH. et al. Presentation, natural history, and management of carotid cavernous aneurysms. Neurosurgery 2005; 57 (05) 850-857
    CrossrefPubMedSuche in Google Scholar
  • 4 Rinkel GJE, Djibuti M, Algra A. van Gijn J. Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke 1998; 29 (01) 251-256
    CrossrefPubMedSuche in Google Scholar
  • 5 Nakagawa T, Hashi K. The incidence and treatment of asymptomatic, unruptured cerebral aneurysms. J Neurosurg 1994; 80 (02) 217-223
    CrossrefPubMedSuche in Google Scholar
  • 6 Freda PU, Post KD. Differential diagnosis of sellar masses. Endocrinol Metab Clin North Am 1999; 28 (01) 81-117, vi
    CrossrefPubMedSuche in Google Scholar
  • 7 Pant B, Arita K, Kurisu K, Tominaga A, Eguchi K, Uozumi T. Incidence of intracranial aneurysm associated with pituitary adenoma. Neurosurg Rev 1997; 20 (01) 13-17
    CrossrefPubMedSuche in Google Scholar
  • 8 Curto L, Squadrito S, Almoto B. et al. MRI finding of simultaneous coexistence of growth hormone-secreting pituitary adenoma with intracranial meningioma and carotid artery aneurysms: report of a case. Pituitary 2007; 10 (03) 299-305
    CrossrefPubMedSuche in Google Scholar
  • 9 Suzuki M, Haginomori SI, Terada T. et al. Large intracavernous carotid artery aneurysm. Otol Neurotol 2017; 38 (06) e188-e189
    CrossrefPubMedSuche in Google Scholar
  • 10 Kouskouras C, Charitanti A, Giavroglou C. et al. Intracranial aneurysms: evaluation using CTA and MRA. Correlation with DSA and intraoperative findings. Neuroradiology 2004; 46 (10) 842-850
    CrossrefPubMedSuche in Google Scholar
  • 11 Rustemi O, Alaraj A, Shakur SF. et al. Detection of unruptured intracranial aneurysms on noninvasive imaging. Is there still a role for digital subtraction angiography?. Surg Neurol Int 2015; 6: 175
    CrossrefPubMedSuche in Google Scholar
  • 12 Lehmann P, Saliou G, Page C, Balut A, Le Gars D, Vallée JN. Epistaxis revealing the rupture of a carotid aneurysm of the cavernous sinus extending into the sphenoid: treatment using an uncovered stent and coils. Review of literature. Eur Arch Otorhinolaryngol 2009; 266 (05) 767-772
    CrossrefPubMedSuche in Google Scholar
  • 13 Ranabir S, Baruah MP. Pituitary apoplexy. Indian J Endocrinol Metab 2011; 15 (Suppl. 03) S188-S196
    CrossrefPubMedSuche in Google Scholar