Elsevier

Surgical Neurology

Volume 54, Issue 5, November 2000, Pages 361-365
Surgical Neurology

Vascular
Multiple “mirror” aneurysms involving intracavernous carotid arteries and vertebral arteries: case report

https://doi.org/10.1016/S0090-3019(00)00304-9Get rights and content

Abstract

BACKGROUND

Bilateral intracavernous carotid artery aneurysms are rare. Moreover, the proportion of vertebrobasilar aneurysms in association with multiple aneurysms is extremely low. We describe a rare case of “mirror” aneurysms on the bilateral intracavernous carotid and bilateral vertebral arteries.

CASE DESCRIPTION

A 54-year-old male suffered from ophthalmic pain and oculomotor palsy on the left side. Cerebral angiography disclosed a giant left cavernous aneurysm and large asymptomatic aneurysms on the right intracavernous carotid artery and bilateral vertebral arteries. The cavernous sinus syndrome on the left side was successfully treated by left carotid artery ligation. However, 2 years later, severe subarachnoid hemorrhage (SAH) occurred. Computed tomography revealed thick clots densely distributed in the basal cisterns and third and fourth ventricles, indicating that the SAH originated from one of the vertebral artery aneurysms. Consciousness disturbance progressed rapidly, leading to cardiopulmonary arrest.

CONCLUSION

The literature contains no case of mirror intracranial aneurysms involving both intracavernous carotid and vertebral arteries. Multi-staged surgical techniques with optimal combinations of direct clipping, ligation or trapping, and endovascular embolization may be essential for patients with multiple aneurysms to avoid SAH.

Section snippets

Case report

A 54-year-old male experienced transient double vision and left facial dysesthesia in 1982. He developed worsening double vision again in December 1983, and was admitted to our hospital in March 1984. He was alert and exhibited no motor or sensory disturbances in the extremities. Moderate left forehead and ophthalmic pain was noted. Severe oculomotor palsy was observed on the left side, but light reflex was preserved bilaterally. Other cranial nerves including abducens and trochlear nerves were

Discussion

The characteristic anatomical structure of the intracranial arteries—that is, poorly developed external elastic lamina and adventitia, gaps in the muscular layer, and a great number of collagenous fibers—contributes to the formation of cerebral aneurysms. Indeed, previous reports concerning familial intracranial aneurysms 9, 13, 18, 22, 27 and recent experimental and clinical studies 1, 4, 6, 12, 17 have strongly suggested that a lack of connective tissue in the arterial wall is one of the

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