Spontaneous Thrombosis of Giant Cavernous Internal Carotid Artery Aneurysm in a Neonate

Abstract

Neonatal intracranial aneurysms are rare, with only 20cases being reported in the literature. No case of spontaneous resolution of a giant intracranial cavernous segment aneurysm in a neonate is reported till date. The authors describe a 3-week-old male child who presented with a left-sided tonic seizure episode and was diagnosed as having a right-sided giant cavernous internal carotid artery aneurysm. The aneurysm was found to be totally thrombosed on angiography done before planning definitive treatment. The child is doing well at 2 years of follow-up. Spontaneous thrombosis, an exceptionally rare but fortunate outcome in a rare case of giant neonatal internal carotid artery aneurysm, has led the authors to report this case. The need of repeat imaging or angiography should be considered to rule out this rare outcome, more so if there is any delay between the ictus and treatment.

A thrombosing, giant, distal posterior cerebral artery aneurysm in a newborn infant

“…Because of this unstable condition, they stressed the importance of repeated DSA or MRA before embarking on any form of treatment. 13 The question remains as to why almost all cerebral aneurysm patients have similar factors, as described above, but only a small portion of them have spontaneous thrombosis. The rarity of the condition hampers discovery of the exact pathophysiology.…”

“…4,14 Supporting these theories are some reported cases in which intracranial aneurysms completely disappeared after diagnostic angiography. 4,14,37 Kasliwal et al 13 reported a case of 3-week-old neonate with a right-side giant cavernous ICA aneurysm. The aneurysm was found to be totally thrombosed on DSA before planning definitive treatment.…”

High-flow bypass with radial artery graft for cavernous carotid aneurysm

“…Spontaneous thrombosis of giant CCA had also been reported. [ 7 ] Stiebel-Kalish et al . published the follow-up results of treated and untreated patients of CCAs.…”

Post-traumatic Cavernous Carotid Pseudoaneurysm with Delayed Epistaxis

“…Large transitional variant of these aneurysms, which has an intradural component can press against the optic nerve and result in visual symptoms. These intradural variants also carry a risk of subarachnoid hemorrhage (0.2%–0.4%) [ 6 ]. Rupture of a CCA more typically results in an arteriovenous (AV) fistula between the ICA and the cavernous sinus.…”