Case Of the Week (COW) 13 December 2015
ICA Aneurysm
Findings
Saccular aneurysm arising from cavernous segment of left internal carotid artery with a well defined thrombus in the centre.
Discussion
Aneurysms can involve common carotid artery, ICA, ECA, or their branches or vertebral arteries. These aneurysms occur most frequently in the ICA, followed by the vertebral artery and least frequently in the ECA and its branches. Among extradural ICA aneurysms, cavernous segment is most commonly affected (80%) and they are often giant aneurysms. ICA aneurysms are either developmental or traumatic; atherosclerotic and mycotic aneurysms are uncommon. ECA and vertebral artery aneurysms are mostly traumatic. The patients may present with TIA, epistaxis, expanding neck mass, cranial nerve palsies or they may be asymptomatic. These aneurysms, particularly those near skull base like petrous/cavernous part of ICA are difficult to treat by surgery due to limited access. They are, however, amenable to endovascular therapy with high cure rates. Nontraumatic Carotico-Cavernous Fistulas also called spontaneous CCFs can be due to the rupture of an intracavernous ICA aneurysm. Pretherapeutic evaluation with CTA/MRA is often required to assess the size of aneurysm, the complete extent of trauma and associated complications if any.
Contributed By:
Prof. S. Babu Peter, Dr. P. Karthik
Barnard Institute of Radiology
ICA Aneurysm
Findings
Saccular aneurysm arising from cavernous segment of left internal carotid artery with a well defined thrombus in the centre.
Discussion
Aneurysms can involve common carotid artery, ICA, ECA, or their branches or vertebral arteries. These aneurysms occur most frequently in the ICA, followed by the vertebral artery and least frequently in the ECA and its branches. Among extradural ICA aneurysms, cavernous segment is most commonly affected (80%) and they are often giant aneurysms. ICA aneurysms are either developmental or traumatic; atherosclerotic and mycotic aneurysms are uncommon. ECA and vertebral artery aneurysms are mostly traumatic. The patients may present with TIA, epistaxis, expanding neck mass, cranial nerve palsies or they may be asymptomatic. These aneurysms, particularly those near skull base like petrous/cavernous part of ICA are difficult to treat by surgery due to limited access. They are, however, amenable to endovascular therapy with high cure rates. Nontraumatic Carotico-Cavernous Fistulas also called spontaneous CCFs can be due to the rupture of an intracavernous ICA aneurysm. Pretherapeutic evaluation with CTA/MRA is often required to assess the size of aneurysm, the complete extent of trauma and associated complications if any.
Contributed By:
Prof. S. Babu Peter, Dr. P. Karthik
Barnard Institute of Radiology