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
› Author Affiliations

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.



Publication History

Publication Date:
19 December 2020 (online)

© 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