Bacterial cavernous sinus aneurysm treated by detachable balloon technique.

Abstract

We describe a patient who developed bilateral cavernous sinus septic thrombosis secondary to a suppurative lesion on the left cheek. Despite clinical improvement, left oculomotor symptoms recurred suddenly. A carotid artery aneurysm within the cavernous sinus was diagnosed by means of magnetic resonance imaging and confirmed by digital angiography. Follow-up angiograms showed an initial decrease in the aneurysm size, with subsequent enlargement. A latex contrast-filled balloon was successfully placed within the aneurysm, preserving the carotid parent artery blood flow. Our case illustrates the usefulness of the detachable balloon technique in the treatment of bacterial aneurysms of the cavernous sinus as an alternative treatment to carotid artery ligation. (Stroke 1989;20:1751-1754

Intracranial Microbial Aneurysm (Infectious Aneurysm): Current Options for Diagnosis and Management

“…Endovascular Therapy (EVT) Since 1990, more than 30 cases of endovascular therapy for MA had been reported [1,[15][16][17][35][36][37][38][39][40][41][42][43][44][45][46]. Guglielmi detachable coils (GDCs) are preferred for proximal aneurysm, while distal aneurysms that are not accessible through microcatheter, are managed with glue or autologous clot injections.…”

Endovascular Treatment of Infective Aneurysms of the Bilateral Cavernous Sinus

“…In some cases, volume reduction or even resolution of the aneurysm has been observed under antibiotic treatment alone. 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].…”

“…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 another report published by otolaryngologists [5], endovascular coil placement was performed and clinical symptoms partially regressed, but the radiologic result was not mentioned.…”

“…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].…”

Septic Cavernous Sinus Thrombosis Complicated by Narrowing of the Internal Carotid Artery, Subarachnoid Abscess and Multiple Pulmonary Septic Emboli

“…External ophthalmoplegia, trigeminal neuralgia, and the narrowing of the internal carotid artery in this case reflect these anatomical features. The reported abnormal findings of the internal carotid artery in septic CST include stenosis (10), occlusion (11) and aneurismal formation (4,(12)(13)(14) at the intracavernous portion. Septic pulmonary emboli in the present case were considered to result from hematogenous dissemination via the right side of the heart.…”