Endovascular Treatment of a Giant Petrous Internal Carotid Artery Aneurysm

 

 Buy Article Permissions and Reprints

Abstract

Expansive aneurysms of the petrous internal carotid artery are rare. Compressive and thrombembolic neurological deficits and occasionally extradural haemorrhage in combination with a pulsatile tinnitus are most important and alarming symptoms. Due to its extradural location, subarachnoid haemorrhage does not occur. Treatment is indicated since rupture may be devastating and recurrent ischaemic attacks severely disabling. Because direct neurosurgical access to the petrous internal carotid artery is very difficult, treatments consists of parent vessel occlusion with or without extra-intracranial bypass construction. We present a case of a young man with a giant petrous artery aneurysm provoking a thrombembolic event which was treated successfully with proximal balloon occlusion of the internal carotid artery after a temporary balloon occlusion test.

References

• 1 Morris P. Practical Neuroangiography. Williams and Wilkins 1997: 117-163
  Google Scholar
• 2 Tanaka H, Patel U, Shrier D A, Coniglio J U. Pseudoaneurysm of the petrous internal carotid artery after skull base infection and prevertebral abscess drainage.  AJNR. 1998;  19 502-504
  PubMedGoogle Scholar
• 3 Cross D T, Moran C J, Brown A P, Oser A B, Goldberg D E, Diego J, Dacey R G. Endovascular treatment of epistaxis in a patient with tuberculosis and a giant petrous carotid pseudoaneurysm.  AJNR. 1995;  16 1084-1086
  PubMedGoogle Scholar
• 4 McGrail K M, Heros R C, Debrun G, Beyeri B. Aneurysm of the ICA petrous segment treated by balloon entrapment after EC-IC bypass.  J Neurosurg. 1986;  65 249-252
  PubMedGoogle Scholar
• 5 Lempert T E, Halbach V V, Higashida R T, Dowd C F, Urwin R W, Balousek P A, Hieshima G B. Endovascular treatment of pseudoaneurysms with electrolytically detachable coils.  AJNR. 1998;  19 907-911
  PubMedGoogle Scholar
• 6 Alimi Y S, Mauro P di, Fiacre E, Magnan J, Juhan C. Blunt injury to the internal carotid artery at the base of the skull: six cases of venous graft restoration.  J Vasc Surg. 1996;  24 249-257
  CrossrefPubMedGoogle Scholar
• 7 Vasama J P, Ramsay H, Markkola A. Petrous internal carotid artery pseudoaneurysm due to gunshot injury.  Ann Otol Rhinol Laryngol. 2001;  110 491-493
  PubMedGoogle Scholar
• 8 Holtzman R NN, Parisier S C. Acute spontaneous otorrhagia resulting from a ruptured petrous carotid aneurysm.  J Neurosurg. 1979;  51 258-261
  PubMedGoogle Scholar
• 9 Cheng K M, Chan C M, Cheung Y L, Chiu H M, Tang K W, Law C K. Endovascular treatment of radiation induced petrous internal carotid artery aneurysm presenting with acute haemorrhage. A report of two cases.  Acta Neurochirurgica. 2001;  143 351-356
  CrossrefPubMedGoogle Scholar
• 10 Frank E, Brown B M, Wilson D F. Asymptomatic fusiform aneurysm of the petrous carotid artery in a patient with von Recklinghausen's neurofibromatosis.  Surg Neurol. 1989;  32 75-78
  PubMedGoogle Scholar
• 11 Guha A, Montanera W, Hoffman H J. Congenital aneurysmal dilatation of the petrous cavernous carotid artery and vertebral basilar junction in a child.  Neurosurgery. 1990;  26 322-327
  PubMedGoogle Scholar
• 12 Jordan J, Rollins N, Lewis M, Roland P. Congenital internal carotid artery aneurysm with absence of the petrous portion of the contralateral internal carotid artery.  Ann Otol Rhinol Laryngol. 2000;  109 1167-1169
  PubMedGoogle Scholar
• 13 Hesselinck J, Weber A. Petrous carotid aneurysm.  Ann Otol Rhino Laryngol. 1983;  92 207-208
  PubMedGoogle Scholar
• 14 Couldwell W T, Zuback J, Onios E, Ahluwalia B S, Tenner M, Moscatello A. Giant petrous carotid aneurysm treated by submandibular carotid-saphenous vein bypass.  J Neurosurg. 2001;  94 806-810
  PubMedGoogle Scholar
• 15 Saeed S R, Hinton A E, Ramsden R T, Lye R H. Spontaneous dissection of the intrapetrous internal carotid artery.  J Laryngol Otol. 1990;  104 491-493
  CrossrefPubMedGoogle Scholar
• 16 Depauw P, Caekebeke J, Hoenacker P van. Objective pulsatile tinnitus caused by intrapetrous dissecting aneurysm. A case report.  Clin Neurol Neurosurg. 2001;  103 197-199
  CrossrefPubMedGoogle Scholar
• 17 Silverman I E, Wityk R J. Transient migraine like symptoms with internal carotid artery dissection.  Clin Neurol Neurosurg. 1998;  100 116-120
  CrossrefPubMedGoogle Scholar
• 18 Schievinck W I, Piepgras D G, McCaffrey T V, Mokri B. Surgical treatment of extracranial internal carotid artery dissecting aneurysms.  Neurosurgery. 1994;  35 809-816
  PubMedGoogle Scholar
• 19 Coley S, Clifton A, Britton J. Giant aneurysm of the petrous internal carotid artery: diagnosis and treatment.  J Laryngol Otol. 1998;  112 196-198
  PubMedGoogle Scholar
• 20 Reece P, Higgings N, Hardy D, Moffat D. An aneurysm of the petrous internal carotid artery.  J Laryngol Otol. 1999;  113 55-57
  PubMedGoogle Scholar
• 21 Ross I B, Weill A, Piotin M, Moret J. Endovascular treatment of distally located giant aneurysms.  Neurosurgery. 2000;  47 1147-1153
  CrossrefPubMedGoogle Scholar
• 22 Mericle R A, Lanzino G, Wakhloo A K, Guterman L R, Hopkins L N. Stenting and secondary coiling of intracranial internal carotid artery aneurysm: technical case report.  Neurosurgery. 1998;  43 1229-1233
  CrossrefPubMedGoogle Scholar
• 23 Lanzino G, Wakhloo A K, Fessler R D, Hartney M L, Guterman L R, Hopkins L N. Efficacy and current limitations of intravascular stents for intracranial internal carotid, vertebral, and basilar artery aneurysms.  J Neurosurg. 1999;  91 538-546
  CrossrefPubMedGoogle Scholar
• 24 Chang S, Steinberg G. Superficial temporal artery to middle cerebral artery anastomosis.  Techniques in Neurosurgery. 2000;  60 86-100
  PubMedGoogle Scholar

Dr. Paul Depauw

Department of Neurosurgery · Elisabeth Hospital

Hilvarenbeekseweg 60

5022 GC Tilburg

The Netherlands

Phone: +31-13-539-1313

Fax: +31-13-542-4031

Email: paul.depauw@excite.com