Carotid cave aneurysm (coiled) and MCA fenestration

Case contributed by A.Prof Frank Gaillard

Presentation

Incidental finding.

Patient Data

Age: 50 years
Gender: Male

The MRA shows a left carotid cave aneurysm projecting 4 mm medially and having a 2 mm neck. There is also subtle protuberance at the infero-medial aspect of the right internal carotid artery in a similar location, suspicious for a further (albeit smaller) aneurysm.

Modality: DSA (angiography)

Unruptured 4.5 millimetre medially projecting transitional aneurysm of the left internal carotid artery, carotid cave, likely totally or in part intra dural. Patient elects for treatment. 

Informed consent obtained in clinic. Pre-medicated with 100mg Aspirin and 75 mg Clopidogrel for 4 days. Sterile technique. Right 6-F CFA retrograde sheath. Systemic heparinisation.  Diagnostic angiography confirm no change from the recent study.

6-French Cook shuttle sheath into the left internal carotid artery, 6-French neuron guide catheter, SL 10 90\XB0\, and Scepter C 4 x 10 balloon catheter placed. Balloon remodelling-5 coils placed, Target 360 standard, soft, and Ultra soft respectively: 4 x 15:3 x 6:2 x 4, 2 x 4, 2 x 3 Raymond class 1-complete obliteration aneurysm, no major graphic complication, no stent placed.

No coil related or embolic complications detected.

Case Discussion

Carotid cave aneursyms have a complex relationship to the dura, and it is difficult to determine on imaging if they intra or extradural. Their neck is considered intradural and in general they are thus thought to present a risk for subarachnoid haemorrhage (which purely extradural cavernous sinus aneurysms do not). 

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Case Information

rID: 25989
Case created: 20th Nov 2013
Last edited: 1st Nov 2015
Inclusion in quiz mode: Included

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