A case of multiple cranial nerve palsy due to sphenoid sinusitis complicated by cerebral aneurysm

Infectious aneurysm of the intracavernous carotid artery occurring concomitantly with sphenoid sinusitis; an autopsy case report

“…The cause of this syndrome includes neoplasmas, vascular lesions, non-infectious inflammation, and bacterial or fungal infections [4]. Suzuki et al [5] suggested that an aneurysm of the cavernous portion of ICA may occur when the cavernous sinus syndrome develops in association with sinusitis, facial furuncles, middle ear infections, dental infections, or meningitis. In the present case, there was no pathogen identified by culture or pathological investigation.…”

Endovascular Treatment of Infective Aneurysms of the Bilateral Cavernous Sinus

“…However, many reports have shown the progressive enlargement of aneurysms under antibiotic treatment [1,4,6,12,13]. In addition, the good results of endovascular treatment described in different reports are a further argument not to delay endovascular treatment anymore [4][5][6][7][8][9]. In our patient, we considered nonmedical treatment because his neurologic symptoms did not improve despite administration of an empirical antibiotic for 1 month and vancomycin for 1 week.…”

“…However, only three trials used endovascular techniques to treat infective aneurysms of the cavernous sinus while sparing the parent vessel [4][5][6]. In the first report by Micheli et al [4], a contrast-filled balloon was placed within the aneurysmal sac with preservation of the carotid artery flow.…”

“…In the first report by Micheli et al [4], a contrast-filled balloon was placed within the aneurysmal sac with preservation of the carotid artery flow. In another report published by otolaryngologists [5], endovascular coil placement was performed and clinical symptoms partially regressed, but the radiologic result was not mentioned. In the series published by Yen et al, stent-assisted vessel wall remodeling technique with preservation of the parent arteries was successfully performed without coil compaction [6].…”

“…Mycotic aneurysms of the bilateral intracavernous sinus are extremely rare [1][2][3][4][5][6]. There are various reports on the treatment of these lesions such as carotid ligation on symptomatic and wrapping on contralateral side [3], extracranial-intracranial (EC-IC) bypass with ligation on both sides [2], carotid ligation only on symptomatic side [1], direct balloon occlusion within the aneurysmal sac with preservation of the carotid artery blood flow [4], stent-assisted vessel wall remodeling technique with preservation of the parent arteries on both sides [6].…”