An aneurysm of the petrous internal carotid artery

Abstract

Internal carotid artery aneurysms are a rare cause of pulsatile tinnitus and conductive hearing loss but should be borne in mind when there is a suspected diagnosis of glomus jugulare or high-riding jugular bulb. Most cases are congenital. We present a case of otorrhagia which was initially thought to be a glomus jugulare, the diagnosis of internal carotid artery aneurysm was made at angiography and treated by balloon embolization.

Aneurysms of the petrous internal carotid artery: anatomy, origins, and treatment

“…Nevertheless, they can produce a wide range of clinical signs and symptoms, depending on the aneurysm's size, direction of growth, and location within the carotid canal. Typically, patients present with symptoms in the third de- cade of life; 29,52 these commonly include headaches, 10,27,52,66 diplopia, 27 Horner syndrome, 10,25,52 facial numbness, 23,42 facial palsy, 27,42 pulsatile tinnitus, 27,53,66 dizziness, 42 or hearing loss. 10,25,27,42,43,53 Symptoms arise as a result of hemorrhage into or mass effect on neighboring structures of the carotid canal.…”

“…Various combinations of single or multiple cranial nerve deficits associated with epistaxis, otorrhagia, vertigo, and dizziness have been reported. 25,53 Because the ICA is surrounded by the sympathetic plexus, aneurysms in this location can present with Horner syndrome. 52 Neurological deficits may occur due to compressive cranial nerve palsy or thromboembolic ischemic events.…”

“…10 Although open surgical ligation of the common carotid artery or ICA is a well-described treatment for these aneurysms, 32,43,52,55 a similar result can be achieved by a less invasive endovascular occlusion. 10,14,21,25,53 …”

“…Aneurysms in the petrous segment have been treated with parent artery occlusion by using endovascular balloon embolization since it was first described in 1978, 10,14,21,25,53 and more recently with coil occlusion. This method has been successful in relieving the symptoms from petrous ICA aneurysms.…”

“…10,21,25,29 In this procedure, a balloon is directed into the ICA immediately proximal to the aneurysm through a guide catheter from the common femoral artery. 10,25,53 First, a balloon occlusion test is performed before parent artery occlusion of the ICA to evaluate for adequate collateral flow. 10,25,53 While the balloon remains inflated for 30 minutes during the test occlusion, the patient is awake and is monitored with serial neurological examinations to evaluate for new deficits and with angiography to assess the collateral circulation, including the vertebral arteries and contralateral ICA.…”