An unusual presentation of “Mirror-Image” bilateral giant carotid cavernous aneurysms: Case report and review of the literature

The almost asymptomatic “mirror-image” bilateral giant intracavernous carotid artery aneurysms are not common and its successful conservative management without further neurological complications is rarely reported. We report a case of a 64-year-old woman, admitted with a rapidly progressive headache, with no other signs or symptoms associated. The Head CT-Scan shows bilateral parasellar round hyperdense lesions and the Magnetic resonance angiography discloses bilateral giant intracavernous carotid artery aneurysms in detail. The clinical presentation of these types of lesions depends on their mass effect on the surrounding neurovascular structures. So, possibly no mass effect on any structure, then no obvious expected symptoms. A patient with these conditions and without neurological deficit should not be rushed to surgery or endovascular treatment.

Opening of unusual vascular collaterals leads to early recanalization of a giant intracavernous carotid artery aneurysm following common carotid artery occlusion: A Case report and literature review

Background: Parent artery occlusion (PAO) with or without bypass surgery is a feasible treatment for large intracavernous carotid artery (ICCA) aneurysms. The ideal occlusion site (internal or common carotid artery [CCA]) and ischemic complications after PAO have received special attention since the description of the technique. Unfrequently, some patients can also develop unusual external carotid artery-internal carotid artery collateral pathways distal to the ligation site that can explain the failure to aneurysm size reduction. Case Description: We describe a rare case of delayed refilling of a large ICCA aneurysm partially thrombosed which early recanalized after surgical ligation of the cervical CCA through an unusual collateral pathway. Conclusion: Based on our experience, we recommend periodic long-term follow-up neuroimaging, especially in those cases where potential collateral branches have not been clearly identified in the preoperative studies.