CT and MRI findings of sphenoid sinus internal carotid artery pseudoaneurysm: An important and challenging differential diagnosis for a skull base mass

Saket, Ramin R.; Hetts, Steven W.; Tatum, J.K.; Glastonbury, Christine M.

doi:10.1016/j.crad.2011.12.009

Cited by 9 publications

(8 citation statements)

References 12 publications

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“…Additional magnetic resonance imaging (MRI) showed peripheral T1-weighted hyperintensity, with a laminated pattern of mixed T1 signal and T2 hypointensity related to blood flow. These findings are similar to a previous neuroimaging study of a sphenoid sinus internal carotid artery pseudoaneurysm 8). However, in our case, the extent and origin of the aneurysm could not be identified with MRI.…”

Section: Discussionsupporting

confidence: 90%

Idiopathic Lenticulostriate Artery Pseudoaneurysm Protruding into the Lateral Ventricle: A Case Report

Kim

Bang

Hwang

et al. 2013

J Cerebrovasc Endovasc Neurosurg

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We report a rare case of an idiopathic pseudoaneurysm causing intraventricular hemorrhage (IVH). A 28-year-old man presented with sudden onset of severe headache. He underwent external ventricular drainage for an isolated IVH in the right lateral ventricle. Digital subtraction angiography (DSA) revealed that the aneurysm (7.5×4.5 mm) arose from the distal part of the medial lenticulostriate artery. Following removal of the external ventricular drainage catheter, the aneurysm decreased in size (4.0×2.3 mm). However, follow-up DSA revealed a slightly enlarged aneurysm (4.2×3.2 mm) with morphologic change. The aneurysm was clipped via the interhemispheric transcallosal approach, but postoperative DSA revealed a residual aneurysm sac beside the clips. Given the risk of rebleeding, a second operation was planned for complete resection of the aneurysm. After revised craniotomy and careful dissection of the caudate nucleus, the aneurysm sac was completely resected. Histopathological examination revealed that the aneurysm was a pseudoaneurysm. The patient recovered without any neurological sequel and was discharged.To the best of our knowledge, this is the first reported case of an idiopathic lenticulostriate artery pseudoaneurysm protruding into the right lateral ventricle and causing an IVH that was successfully treated with microsurgical resection.

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Section: Discussionsupporting

confidence: 90%

Idiopathic Lenticulostriate Artery Pseudoaneurysm Protruding into the Lateral Ventricle: A Case Report

Kim

Bang

Hwang

et al. 2013

J Cerebrovasc Endovasc Neurosurg

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“…Another characteristic finding that is seen only with aneurysms or pseudoaneurysms is the presence of a wide band of pulsation artifact (Fig. D) . Formal angiography is the “gold standard” for confirmation and should be conducted in all cases where pseudoaneurysm is being considered (Figs.…”

Section: Discussionmentioning

confidence: 60%

“…Pseudoaneurysms of the internal carotid artery (ICA) in the cranial base, which includes the petrous, cavernous, and clinoidal segments of the ICA (referred to subsequently as “cranial base pseudoaneurysms”), are rare, likely due to the bony encasement and protection offered by the temporal and sphenoid bones. As endoscopic endonasal surgery (EES) of the anterior cranial base increases in frequency, the number of iatrogenic cranial base pseudoaneurysms may also be increasing . Although it is difficult to discern the exact incidence of cranial base pseudoaneurysms, a recent review suggested that at least 20% of patients undergoing EES with intraoperative arterial injury develop delayed pseudoaneurysms .…”

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confidence: 99%

Diagnosis and endoscopic endonasal management of nontraumatic pseudoaneurysms of the cranial base

Faden

Hughes

Lavigne

et al. 2018

Int Forum Allergy Rhinol

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Symptomatic cranial base pseudoaneurysms should undergo treatment to obliterate the aneurysm and relieve the mass effect. First, formal angiography is necessary for accurate diagnosis and treatment planning. Next, endovascular occlusion is performed, with a preference for coiling or endoluminal reconstruction with a flow diverter. Last, endoscopic intervention follows in cases where: (1) decompression of vital structures is indicated; (2) diagnosis of the pseudoaneurysm cannot be definitively confirmed with angiography; or (3) the etiology of the confirmed pseudoaneurysm requires further investigation.

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“…[ 6 ] Sphenoid sinus pseudoaneurysm is another disease entity caused by damage to the cavernous segment of the ICA, which is rare compared to CCF, and cases with concomitant CCF have rarely been reported. [ 1 , 2 , 7 – 9 ] Theoretically, since the segment of ICA is located in the cavernous sinus, it is difficult to understand that CCF is not accompanied with pseudoaneurysm due to vessel damage. However, anatomically, a part of the cavernous segment of the ICA contacts the lateral wall of the sphenoid sinus to form the carotid sulcus, and the boundary is separated by bones with a thickness of less than 0.5 mm in about 88% of cadaver specimens.…”

Section: Discussionmentioning

confidence: 99%

Sphenoid sinus pseudoaneurysm with carotid cavernous fistula presenting with delayed subarachnoid hemorrhage

Cho¹,

Yi²,

Choi

et al. 2021

Medicine

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Rationale: Sphenoid sinus pseudoaneurysm arising from the cavernous segment of the internal carotid artery (ICA) caused by traumatic vessel injury is rare, and rarer is a concomitant carotid-cavernous fistula (CCF). In particular, delayed subarachnoid hemorrhage (SAH) due to pseudoaneurysm rupture has not been reported to-date in literature. Here, we report a case of sphenoid sinus pseudoaneurysm with CCF presenting with delayed SAH. Patient concerns: A 73-year-old man presented with traumatic brain injury due to motorcycle accident. Diagnoses: Twenty-four days after admission, the patient's neurological status suddenly deteriorated. Brain computed tomography (CT) showed acute SAH along interhemispheric cisterns and suprasellar intracerebral hematoma. Brain CT angiography and digital subtraction angiography revealed giant sphenoid sinus pseudoaneurysm with CCF and the daughter sac of the pseudoaneurysm extended to the intracranial part via fracture in the superior wall of the sphenoid sinus. Interventions: As the sphenoid sinus pseudoaneurysm and CCF shared one rupture point, endovascular treatment with intraarterial approach using coil and liquid embolic material by balloon assisted technique was performed simultaneously. Outcomes: The origin of the pseudoaneurysmal sac and CCF was sufficiently blocked after injection of liquid embolic material and the lesions completely resolved immediately after endovascular treatment. Lessons: Sphenoid sinus pseudoaneurysm and CCF rarely occur following head trauma through a series of processes involving fracture of the lateral wall of the sphenoid sinus and ICA cavernous segment injury. Sphenoid sinus pseudoaneurysm may present as SAH through intracranial rupture with concomitant superior wall fracture of the sphenoid sinus. Therefore, early diagnosis using CT or magnetic resonance angiography and appropriate treatment through understanding the disease mechanism is necessary.

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CT and MRI findings of sphenoid sinus internal carotid artery pseudoaneurysm: An important and challenging differential diagnosis for a skull base mass

Cited by 9 publications

References 12 publications

Idiopathic Lenticulostriate Artery Pseudoaneurysm Protruding into the Lateral Ventricle: A Case Report

Idiopathic Lenticulostriate Artery Pseudoaneurysm Protruding into the Lateral Ventricle: A Case Report

Diagnosis and endoscopic endonasal management of nontraumatic pseudoaneurysms of the cranial base

Sphenoid sinus pseudoaneurysm with carotid cavernous fistula presenting with delayed subarachnoid hemorrhage

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