PMC8168689_01
(a) Bone window computed tomography (CT) demonstrating bony dehiscence of the superolateral wall of the left sphenoid sinus (white arrow). (b and c) Preoperative axial (b) and sagittal reconstruction (c) CT angiography (CTA) showing protrusion of the internal carotid artery (ICA) infectious aneurysm into the left sphenoid sinus (asterisk). (d) Postoperative sagittal CTA demonstrating complete occlusion of the aneurysm (asterisk) and good patency of the supraclinoid ICA.
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F1
Anatomic variation was the bony dehiscence of the superolateral wall of the left sphenoid sinus [Figure 1a], with concomitant carotid artery protrusion into the sinus and separated by the sinus cavity by only dura and mucosa. It showed containment of the infection but revealed a large enhancing lesion protruding into the left sphenoid sinus, which on further CT angiography (CTA) and digital subtraction angiography (DSA) were determined to be a 0.9 x 2 cm infectious irregular multilobulated pseudoaneurysm of the cavernous ICA [Figure 1b, c and 2a]. Follow-up CTA a week after embolization confirmed complete occlusion of the aneurysm with no extension of the aneurysm neck or residual flow [Figure 1d].
(a) Preoperative digital subtraction angiography (DSA) (lateral view) revealed the large left paraophthalmic internal carotid artery infectious aneurysm (white arrow). (b) Postembolization digital subtraction angiography demonstrated complete exclusion of the pseudoaneurysm (white arrow).
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F2
It showed containment of the infection but revealed a large enhancing lesion protruding into the left sphenoid sinus, which on further CT angiography (CTA) and digital subtraction angiography (DSA) were determined to be a 0.9 x 2 cm infectious irregular multilobulated pseudoaneurysm of the cavernous ICA [Figure 1b, c and 2a]. Postembolization angiogram revealed complete exclusion of the pseudoaneurysm with preservation of normal flow in the distal carotid and ophthalmic artery [Figure 2b].