AJDRAJNR - American Journal of Neuroradiology

Published ahead of print on February 22, 2008
doi: 10.3174/ajnr.A1023
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Unruptured Large and Giant Carotid Artery Aneurysms Presenting with Cranial Nerve Palsy: Comparison of Clinical Recovery after Selective Aneurysm Coiling and Therapeutic Carotid Artery Occlusion

W.J. van Rooija and M. Sluzewskia

a From the Department of Radiology, St. Elisabeth Ziekenhuis, Tilburg, the Netherlands


Figure 1
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  		Fig 1. A 48-year-old woman presenting in 1994 with visual field deficit from a right giant carotid ophthalmic aneurysm and acute left ophthalmoplegia from a left-sided carotid cavernous sinus aneurysm. A, Right ophthalmic aneurysm completely occluded with coils (see coil mesh in C and D). B, Left cavernous sinus aneurysm with intraluminal thrombus. Note additional small middle cerebral artery aneurysm. C, Angiogram 7 days after B shows enlargement of the aneurysm by resolution of intraluminal thrombus. D, Loose coil packing after embolization. Follow-up angiograms 6 to 72 months later showed progressive aneurysmal thrombosis with complete occlusion. E and F, MR imaging after 3 weeks (E) and 18 months (F). At 18 months, the aneurysm is almost completely obliterated. Visual field deficit remained unchanged, and ophthalmoplegia improved to isolated abducens palsy.


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  		Fig 2. A 52-year-old man presenting with acute ipsilateral ophthalmoplegia and contralateral CN III palsy with intact vision. A and B, Contrast-enhanced MR imaging (A) and angiography (B) shows giant left carotid hypophyseal aneurysm with intraluminal thrombus. Angiographic test occlusion was not tolerated. C, Angiogram 2 days after B shows enlargement of the aneurysmal lumen due to resolution of thrombus. D, Complete occlusion after stent-assisted coiling. One year later, right ophthalmoplegia was resolved. Residual upper gaze diplopia and 1- to 2-mm residual ptosis on the left side.


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  		Fig 3. A 38-year-old woman presenting with progressive visual field deficit. A, Giant carotid hypophyseal aneurysm compressing the chiasm treated with balloon-assisted coiling. Angiographic test occlusion was not tolerated. B, MR imaging at 3 intervals after coiling. At 12 months, the aneurysm has increased in size from 24 to 31 mm. Size is stable during an interval of 12 to 24 months. C, Perimetric results before coiling and different intervals thereafter. Incomplete hemianopsia before coiling. At 12 months, increased aneurysmal size caused progressive hemianopsia that gradually decreased at 17 and 29 months. Final result was classified as unchanged.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X