False aneurysms of the intracavernous carotid artery — Report of 7 cases

Abstract

We present 7 cases of false intracavernous carotid artery aneurysms. Four occurred after trauma and three were caused iatrogenically. Two of the latter occurred in patients with pituitary adenomas, one after transsphenoidal microsurgery and the other after yttrium [YI90] seed implantation into the sella. The third iatrogenic aneurysm was seen shortly after transcavernous tumour surgery. In five of our seven patients massive, delayed, life-threatening epistaxis was the leading symptom. All traumatic cases were associated with immediate unilateral blindness or blurred vision and with skull base fractures. One of these had a concomitant carotid cavernous fistula. Treatment of choice of our 5 recent cases was permanent balloon occlusion of the intracavernous carotid artery at the level of the lesion. Collateral circulation was evaluated prior to definitive carotid occlusion using a balloon test occlusion. During the balloon test adequate collateral circulation was defined as symmetric angiographic filling of both hemispheres. Awake patients were neurologically examined continuously. In unconscious patients transcranial Doppler sonography, electroencephalographic and somatosensory evoked potential monitoring was used in addition. Intra-operative heparin administration was not reversed with protamin. A postoperative continuous heparin infusion was not found necessary. In our two early cases this technique was not available: In the first case we accomplished aneurysm occlusion by a surgically introduced Fogarty balloon catheter. Our second patient needed surgical trapping of the involved carotid after early unsuccessful attempts of selective aneurysm occlusion. After treatment no further epistaxis occurred. Follow-up angiography showed persistent aneurysm occlusion. The results were excellent in 5 cases and good in 1 case. One patient with bilateral lesions suffered a stroke after occlusion of the second, remaining carotid artery, despite functioning bilateral extra-intracranial bypasses. Four years later there is a mild dysphasia still present in this patient. The mean follow-up time was 75.6 months.

Traumatic Pseudoaneurysm of Internal Carotid Artery presenting as Intractable Epistaxis in a Case of Maxillary Fracture

“…The blood causes an infl ammatory reaction in surrounding tissue with the formation of a fi brous capsular wall and development of an epithelial lining. Continuous pulsatile forces can result in enlargement, weakening and breakdown of the fi brous wall, [3][4][5] which cause repeated bleeding. Patients with traumatic internal carotid artery pseudoaneurysm present with repeated epistaxis that is diffi cult to control, a condition that often leads to hemorrhagic shock or asphyxia and thus seriously threatens life.…”

De Novo Aneurysm in the Feeding Artery of a Recurrent Malignant Glioma -Case Report-

“…Injury to the internal carotid artery encased by the tumor during transsphenoidal or skull base surgery often induces such pseudoaneurysms. 4,15) Third, cerebral aneurysms may occur following cranial irradiation but are less common. 8,27) The cause of such radiation-induced aneurysms remains unknown, but the mechanism is supposed to be similar to that found in radiation-induced vasculopathy; that is, initial damage to endothelial cells predisposes vessels to aneurysmal changes.…”

Pseudoaneurysm of the internal carotid artery presenting with massive (recurrent) epistaxes: a life-threatening complication of craniofacial trauma

“…Transection occurs when complete wall compromising (adventitia, media and intimal) in a partial or complete circumference of the vessel and present as an acute bleeding. In these cases, formation of arteriovenous fistulae (carotidocavernous if occurs inside the cavernous sinus) 2,7 or a pseudoaneurysm 8,9 can be developed.…”

“…The blood causes an inflammatory reaction in surrounding tissue with the formation of a fibrous capsular wall and development of an epithelial lining. Continuous pulsatile forces can result in enlargement, weakening, and breakdown of the fibrous wall [8][9][10] .…”