Cavernous Carotid Aneurysms: To Do or Not To Do?

Abstract

Cavernous carotid aneurysms (CCA) pose considerable dilemmas in management. It is still unclear as to whether an asymptomatic CCA should be subjected to treatment. Similarly, the ideal management strategy for a symptomatic aneurysm is controversial. We present the case of a 60-year-old female with a giant CCA and discuss the management issues.

Keywords: Cavernous carotid aneurysms; cerebral bypass; unruptured aneurysms.

Figure 1

Magnetic resonance imaging (MRI) revealed a well defined extra axial altered signal intensity lesion measuring 4.0 x 4.1 x 3.4 cm in the left parasellar region which was heterogenous on T2W/FLAIR (a and c) iso to hyperintense on T1WI (b), and did not show any diffusion restriction. On post contrast (d) studies the central portion of the lesion showed homogenous intense enhancement while rest of the lesion did not show enhancement

Figure 2

Digital subtraction angiography anteroposterior, lateral and oblique images (a-c) revealed a giant cavernous aneurysms measuring nearly 3.5 cm × 2.4 cm with areas of thrombosis. The aneurysm was seen extending superiorly into the intradural subarachnoid compartment. Cross circulation studies following compression of the left carotid artery revealed inadequate filling of the ipsilateral middle cerebral vessels (d)

Figure 3

Postoperative computed tomography angiogram revealed complete thrombosis of the aneurysm with no evidence of contrast enhancement. (c) The bypass graft showed normal contrast opacification (a and b) and there was no flow detected in the internal carotid artery distal to the occlusion (c)