Suprasellar Displacement of Intracavernous Internal Carotid Artery: Case Report

Neurosurgery ◽  
2003 ◽  
Vol 53 (6) ◽  
pp. 1433-1435 ◽  
Author(s):  
Oren N. Gottfried ◽  
Scott W. Soleau ◽  
William T. Couldwell
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Vascular Anomaly ◽  
Vascular Abnormality ◽  
Bifurcation Aneurysm ◽  
Sinus Wall ◽  
Anatomic Variants ◽  
Cavernous Carotid Artery

Abstract OBJECTIVE AND IMPORTANCE We present a previously undescribed variant of the cavernous internal carotid artery (ICA) and review the literature concerning other variants of the cavernous ICA. CLINICAL PRESENTATION The patient, a 53-year-old woman with fibromuscular dysplasia and multiple intracranial aneurysms, underwent cerebral angiography in preparation for clipping of a terminal ICA bifurcation aneurysm that demonstrated a redundant loop of the cavernous ICA abutting the supraclinoid carotid artery. INTERVENTION The patient underwent a pterional craniotomy to approach a terminal ICA bifurcation aneurysm. During the procedure, an unexpected vascular anomaly was discovered. On further dissection, we confirmed that the vascular abnormality was a segment of the ICA that had herniated through the superomedial cavernous sinus wall. CONCLUSION This case demonstrates that the cavernous ICA may become dehiscent from the cavernous sinus wall and herniate into the suprasellar space. Knowledge and anticipation of anatomic variants of the cavernous carotid artery are essential to avoid inadvertent vascular injury during surgery.

Management of Cavernous Sinus Meningioma Presenting With Cerebrovascular Insufficiency Secondary to Cavernous Carotid Artery Occlusion: Report of 2 Cases

2018 ◽  
Vol 16 (4) ◽  
pp. 503-513 ◽  
Author(s):  
Gmaan Alzhrani ◽  
Nicholas Derrico ◽  
Hussam Abou-Al-Shaar ◽  
William T Couldwell
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Surgical Removal ◽  
Cerebrovascular Insufficiency ◽  
Cavernous Sinus Meningioma ◽  
Cavernous Carotid Artery

Abstract BACKGROUND Surgical removal of cavernous sinus meningiomas is challenging and associated with high morbidities as a result of the anatomic location and the surrounding neurovascular structures that are often invaded or encased by the tumor. Advances in radiotherapy techniques have led to the adoption of more conservative approaches in the management of cavernous sinus meningioma. Internal carotid artery encasement and invasion has been documented in these cases; however, ischemic presentation secondary to internal carotid artery stenosis or occlusion by meningioma in the region of the cavernous sinus is rare, with only few cases reported in the literature. OBJECTIVE To report our surgical technique and experience with bypass grafting for cavernous sinus meningiomas that invade or narrow the internal carotid artery. METHODS We report 2 patients who presented with signs and symptoms attributed to cavernous carotid artery occlusion secondary to cavernous sinus meningioma in the last 5 yr. Both patients were treated with flow augmentation without surgical intervention for the cavernous sinus meningioma. RESULTS In both cases, the clinical and radiological signs of cerebrovascular insufficiency improved markedly, and the patients’ tumors are currently being monitored. CONCLUSION Although the cerebrovascular insufficiency in this subset of patients is attributed to the occlusion of the cavernous carotid artery caused by the tumor, we propose treating those patients with flow augmentation first with or without radiation therapy when there is a clear imaging feature suggestive of meningioma in the absence of significant cranial nerve deficit.

scholarly journals Rare Clinical Onset of Nontraumatic Intracavernous Aneurysm of the Internal Carotid Artery: A Diagnostic and Therapeutic Challenge

2020 ◽  
Author(s):  
Enzo Emanuelli ◽  
Maria Baldovin ◽  
Claudia Zanotti ◽  
Sara Munari ◽  
Luca Denaro ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Arterial Injury ◽  
Sphenoidal Sinus ◽  
Therapeutic Challenge ◽  
Cavernous Sinus Syndrome ◽  
Sellar Lesions ◽  
Risk Of Rupture

AbstractWhile the so-called pseudoaneurysms can result from arterial injury during trans-sphenoidal surgery or after a trauma, spontaneous aneurysms of cavernous–internal carotid artery (CICA) are rare. Symptoms vary and the differential diagnosis with other, more frequent, sellar lesions is difficult. We describe three cases of misdiagnosed CICA spontaneous aneurysm. In two cases the onset was with neuro-ophthalmological manifestations, classifiable as “cavernous sinus syndrome.” The emergency computed tomography scan did not show CICA aneurysm and the diagnosis was made by surgical exploration. The third patient came to our attention with a sudden severe unilateral epistaxis; endonasal surgery revealed also in this case a CICA aneurysm, eroding the wall and protruding into the sphenoidal sinus. When the onset was with a cavernous sinus syndrome, misdiagnosis exposed two patients to potential serious risk of bleeding, while the patient with epistaxis was treated with embolization, using coils and two balloons. Intracavernous nontraumatic aneurysms are both a diagnostic and therapeutic challenge, because of their heterogeneous onset and risk of rupture, potentially lethal. Intracavernous aneurysms can be managed with radiological follow-up, if asymptomatic or clinically stable, or can be surgically treated with endovascular or microsurgical techniques.

scholarly journals Internal Carotid Artery Injury in Transsphenoidal Surgery: Tenets for Its Avoidance and Refit—A Clinical Study

2021 ◽  
Vol 11 (1) ◽  
pp. 99
Author(s):  
Dmitry Usachev ◽  
Oleg Sharipov ◽  
Ashraf Abdali ◽  
Sergei Yakovlev ◽  
Vasiliy Lukshin ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Transsphenoidal Surgery ◽  
Internal Carotid ◽  
Treatment Options ◽  
Carotid Artery Injury ◽  
Anatomical Features ◽  
Stent Grafting ◽  
Internal Carotid Artery Injury

One of the most serious/potentially fatal complications of transsphenoidal surgery (TSS) is internal carotid artery (ICA) injury. Of 6230 patients who underwent TSS, ICA injury occurred in 8 (0.12%). The etiology, possible treatment options, and avoidance of ICA injury were analyzed. ICA injury occurred at two different stages: (1) during the exposure of the sella floor and dural incision over the sella and cavernous sinus and (2) during the resection of the cavernous sinus extension of the tumor. The angiographic collateral blood supply was categorized as good, sufficient, and nonsufficient to help with the decision making for repairing the injury. ICA occlusion with a balloon was performed at the injury site in two cases, microcoils in two patients, microcoils plus a single barrel extra-intracranial high-flow bypass in one case, stent grafting in one case, and no intervention in two cases. The risk of ICA injury diminishes with better preoperative preparation, intraoperative navigation, and ultrasound dopplerography. Reconstructive surgery for closing the defect and restoring the blood flow to the artery should be assessed depending on the site of the injury and the anatomical features of the ICA.

The So-Called Cavernous Sinus: A Review of the Controversy and Its Implications for Neurosurgeons

Neurosurgery ◽  
1982 ◽  
Vol 11 (5) ◽  
pp. 712-717 ◽  
Author(s):  
John N. Taptas
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Cranial Nerves ◽  
Sella Turcica ◽  
Middle Cranial Fossa ◽  
Cranial Fossa ◽  
Base Of The Skull ◽  
Extradural Space

Abstract The so-called cavernous sinus is a venous pathway, an irregular network of veins that is part of the extradural venous network of the base of the skull, not a trabeculated venous channel. This venous pathway, the internal carotid artery, and the oculomotor cranial nerves cross the medial portion of the middle cranial fossa in an extradural space formed on each side of the sella turcica by the diverging aspects of a dural fold. In this space the venous pathway has only neighborhood relations with the internal carotid artery and the cranial nerves. The space itself must be distinguished from the vascular and nervous elements that it contains. The revision of the anatomy of this region has not only theoretical interest but also important clinical implications.

scholarly journals Trapping, dome puncture, and direct suction decompression in conjunction with assistant superficial temporal artery- middle cerebral artery bypass to clip giant internal carotid artery bifurcation aneurysm

2019 ◽  
Vol 10 ◽  
pp. 205
Author(s):  
Seiei Torazawa ◽  
Hideaki Ono ◽  
Tomohiro Inoue ◽  
Takeo Tanishima ◽  
Akira Tamura ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Optimal Treatment ◽  
Aneurysm Neck ◽  
Bifurcation Aneurysm

Background: Very large and giant aneurysms (≥20 mm) of the internal carotid artery (ICA) bifurcation (ICAbif) are definitely rare, and optimal treatment is not established. Endovascular treatments are reported as suboptimal due to difficulties of complete occlusion and tendencies to recanalization. Therefore, direct surgery remains an effective strategy if the clipping can be performed safely and reliably, although very difficult. Case Description: Two cases of ICAbif aneurysms (>20 mm) were treated. Prior assistant superficial temporal artery (STA)-middle cerebral artery (MCA) bypass was performed to avoid ischemic complications during prolonged temporary occlusion of the arteries in both cases. In Case 1 (22-mm aneurysm), the dome was inadvertently torn in applying the clip because trapping had resulted in insufficient decompression. Therefore, in Case 2 (28-mm aneurysm), almost complete trapping of the aneurysm and subsequent dome puncture was performed, and the aneurysm was totally deflated by suction from the incision. This complete aneurysm decompression allowed safe dissection and successful clipping. Conclusion: Trapping, deliberate aneurysm dome puncture, and suction decompression from the incision in conjunction with assistant STA-MCA bypass can achieve complete aneurysm deflation, and these techniques enable safe dissection of the aneurysm and direct clipping of the aneurysm neck. Direct clipping with this technique for very large and giant ICAbif aneurysms may be the optimal treatment choice with the acceptable outcome if endovascular treatment remains suboptimal.

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