Bilateral cavernous carotid aneurysms treated by two-stage extracranial-intracranial bypass followed by parent artery occlusion: case report and literature review
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Bilateral cavernous carotid aneurysms (CCAs) are often not amenable to neurosurgical clipping or endovascular coiling. Here, we report the case of a 50-year-old female who presented with a 1-year history of gradual severe headache. Preoperative angiograms revealed bilateral CCAs. Among these findings, the right giant CCA had been trapped after the external carotid artery-saphenous vein-middle cerebral artery (ECA-SV-MCA) bypass 8 years prior. Additionally, the left CCA was again trapped after the internal maxillary artery-radial artery-middle cerebral artery (IMA-RA-MCA) bypass, followed by parent artery occlusion (PAO), because of the enlargement of a 0.4-cm aneurysm to a 1.3-cm aneurysm during the 5th to 8th years following surgery. Postoperative radiologic findings proved that the aneurysms disappeared with good graft patency of the bilateral anastomoses and excellent filling of the bilateral MCA territories. This is the first case of bilateral CCAs treated with two stages of bilateral high-flow extracranial-intracranial (EC-IC) bypass, including an IMA-RA-MCA bypass.
KeywordsCavernous carotid aneurysms Extracranial–Intracranial bypass Internal maxillary artery Enlargement Bilateral bypass
This work was supported by the grant: Beijing Municipal Natural Science Foundation (grant no. 7161005 to Xiang’en Shi) and the Science and Technology Commission Foundation of Beijing (grant no. Z161100000516019 to Xiang’en Shi)
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The patient/next of kin/guardian has consented to submission of this case report to the journal.
Conflicts of interest
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