Two rare cases of traumatic aneurysm involving intracranial carotid arteries are reported.
A 58-year-old man was admitted, with the chief complaint of visual disturbance. The patient had been treated with radiation under the diagnosis of pituitary tumor 7 years prior to admission. A CT scan demonstrated a pituitary tumor with suprasellar extension. Bilateral carotid angiograms demonstrated lateral displacement of the proximal supraclinoid carotid arteries. There was no medial displacement of the cavernous portion of the internal carotid artery. A right fronto-temporal craniotomy was performed. During intracapsular removal of the tumor, massive bleeding from the left medial wall of the sella which was considered to be from the left internal carotid artery, suddenly occurred. The hemorrhage was controlled by packing with oxycell. On the third postoperative day, the patient complained of double vision. A left carotid angiography demonstrated a multilobed false aneurysm in the cavernous portion of the left internal carotid artery. The aneurysm was then successfully treated by trapping of extra-and intracranial carotid ligation. The patient was discharged with left visual disturbance and left opthalmoplegia.
A 22-year-old man was rendered unconscious by a blow to the face and admitted semicomatose, with fixed and dilated pupil on the right side. An emergency CT scan demonstrated massive subarachnoid hemorrhage in the basal cisterns and clots in the right frontal lobe as well as in the lateral ventricles. External decompression and ventricular drainage were performed. A postoperative carotid angiography on the right demonstrated a irregular narrowing of the supraclinoid carotid artery. After the operation, the neurological status improved with intensive medical treatment. Two weeks later, however, the patient suddenly became comatose with decerebrate rigidity. A right carotid angiography demonstrated a bilobed aneurysm of the supraclinoid portion and marked narrowing of C₂ portion of the internal carotid artery. An emergency operation for radical treatment of the false aneurysm was performed after the third episode of bleeding. The previous craniotomy was reopened and massive subarachnoid hemorrhage around the right internal carotid artery was removed following evacuation of frontal intracerebral hematoma. The aneurysm involved both the C₁ portion of internal carotid artery and carotid bifurcation. During the dissection, the aneurysm ruptured and bled profusely. The hemorrhage was controlled by ligation of the right internal carotid artery at the neck, and the dome of the aneurysm was coated with a muscle piece. Postoperatively, the patient remained in a persistent vegetative state. In this report, possible mechanisms causing these false aneurysms are described.