Search tips
Search criteria 


Logo of skullbasesurgInstructions for AuthorsSubscribe to Skull BaseAbout Skull BaseEditorial BoardThieme Medical PublishingSkull Base An Interdisciplinary Approach ...
Skull base surgery. 1999; 9(1): 65–70.
PMCID: PMC1656721

A Giant Thrombosed Aneurysm of the Petrous Carotid Artery Presenting with Cavernous Sinus Syndrome

Case Report


Aneurysms involving the petrous Carotid artery are rare and a review of the literature demonstrates that the mode of clinical presentation depends on the direction of expansion of the aneurysmal sac. The eighth nerve is the most commonly affected, followed by the fifth nerve, sixth nerve and seventh nerve, respectively. There has not been reported to date a lesion presenting with cavernous sinus syndrome. We present the case of a 46-year-old woman who complained of left facial pain and pan-ophthalmoplegia, and was shown to have a giant thrombosed aneurysm of the petrous carotid artery extending into the cavernous sinus. Because preoperative evaluation of the patient revealed good collateral flow, proximal balloon occlusion of the left internal carotid artery was performed. Neurological symptoms of the patient resolved 2 months after surgery except for the size of the left pupil. We conclude that an aneurysm of the petrous carotid artery should be included in the differential diagnosis of cases presenting with a cavernous sinus syndrome. Early diagnosis followed by definitive treatment is important for the alleviation of clinical symptoms associated with this lesion.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (2.5M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Anderson RD, Liebeskind A, Schechter MM, Zingesser LH. Aneurysms of the internal carotid artery in the carotid canal of the petrous temporal bone. Radiology. 1972 Mar;102(3):639–642. [PubMed]
  • Busby DR, Slemmons DH, Miller TF., Jr Fatal epistaxis via carotid aneurysm and eustachian tube. Arch Otolaryngol. 1968 Mar;87(3):295–298. [PubMed]
  • GUIRGUIS S, TADROS FW. An internal carotid aneurysm in the petrous temporal bone. J Neurol Neurosurg Psychiatry. 1961 Feb;24:84–85. [PMC free article] [PubMed]
  • Halbach VV, Higashida RT, Hieshima GB, Dowd CF, Barnwell SL, Edwards MS, Melicharek M. Aneurysms of the petrous portion of the internal carotid artery: results of treatment with endovascular or surgical occlusion. AJNR Am J Neuroradiol. 1990 Mar-Apr;11(2):253–257. [PubMed]
  • HIRANANDANI LH, CHANDRA O, MALPANI NK, AHUJA KK. An internal carotid aneurysm in the petrous temporal bone. J Laryngol Otol. 1962 Sep;76:703–706. [PubMed]
  • Holtzman RN, Parisier SC. Acute spontaneous otorrhagia resulting from a ruptured petrous carotid aneurysm. Case report. J Neurosurg. 1979 Aug;51(2):258–261. [PubMed]
  • Kudo S, Colley DP. Multiple intrapetrous aneurysms of the internal carotid artery. AJNR Am J Neuroradiol. 1983 Sep-Oct;4(5):1119–1121. [PubMed]
  • Lynch JC, Amaral MA, Pareira A. Giant aneurysm of the petrous portion of the carotid artery. J Neurol Neurosurg Psychiatry. 1983 Jul;46(7):685–687. [PMC free article] [PubMed]
  • Moffat DA, O'Connor AF. Bilateral internal carotid aneurysms in the petrous temporal bones. Arch Otolaryngol. 1980 Mar;106(3):172–175. [PubMed]
  • Morantz RA, Kirchner FR, Kishore P. Aneurysms of the petrous portion of the internal carotid artery. Surg Neurol. 1976 Dec;6(6):313–318. [PubMed]
  • Rawlinson J, Colquhoun IR. Aneurysms involving the intrapetrous internal carotid artery: a rare cause of Horner's syndrome. Br J Radiol. 1990 Jan;63(745):69–72. [PubMed]
  • Umezu H, Seki Y, Aiba T, Kumakawa K. Aneurysm arising from the petrous portion of the internal carotid artery: case report. Radiat Med. 1993 Nov-Dec;11(6):251–255. [PubMed]
  • Wemple JB, Smith GW. Extracranial carotid aneurysm. Report of four cases. J Neurosurg. 1966 Mar;24(3):667–671. [PubMed]
  • Gibson RD, Cowan IA. Giant aneurysm of the petrous carotid artery presenting with facial numbness. Neuroradiology. 1989;31(5):440–441. [PubMed]
  • McGrail KM, Heros RC, Debrun G, Beyerl BD. Aneurysm of the ICA petrous segment treated by balloon entrapment after EC-IC bypass. Case report. J Neurosurg. 1986 Aug;65(2):249–252. [PubMed]
  • Kelly WM, Harsh GR., 4th CT of petrous carotid aneurysms. AJNR Am J Neuroradiol. 1985 Sep-Oct;6(5):830–832. [PubMed]
  • Costantino PD, Russell E, Reisch D, Breit RA, Hart C. Ruptured petrous carotid aneurysm presenting with otorrhagia and epistaxis. Am J Otol. 1991 Sep;12(5):378–383. [PubMed]
  • BARRETT JH, LAWRENCE VL. Aneurysm of the internal carotid artery as a complication of mastoidectomy. Arch Otolaryngol. 1960 Sep;72:366–368. [PubMed]
  • Cross DT, 3rd, Moran CJ, Brown AP, Oser AB, Goldberg DE, Diego J, Dacey RG. Endovascular treatment of epistaxis in a patient with tuberculosis and a giant petrous carotid pseudoaneurysm. AJNR Am J Neuroradiol. 1995 May;16(5):1084–1086. [PubMed]
  • Willinsky R, Lasjaunias P, Pruvost P, Boucherat M. Petrous internal carotid aneurysm causing epistaxis: balloon embolization with preservation of the parent vessel. Neuroradiology. 1987;29(6):570–572. [PubMed]
  • Teal JS, Bergeron RT, Rumbaugh CL, Segall HD. Aneurysms of the petrous or cavernous portions of the internal carotid artery associated with nonpenetrating head trauma. J Neurosurg. 1973 May;38(5):568–574. [PubMed]
  • Date I, Ohmoto T. Long-term outcome of surgical treatment of intracavernous giant aneurysms. Neurol Med Chir (Tokyo) 1998;38 (Suppl):62–69. [PubMed]
  • Allen GW. Angiography in otolaryngology. Laryngoscope. 1967 Nov;77(11):1909–1961. [PubMed]
  • DelBalso AM, Bowers JE. Aneurysm of intrapetrous carotid artery: CT and angiographic findings. J Comput Assist Tomogr. 1986 Jul-Aug;10(4):702–703. [PubMed]

Articles from Skull Base Surgery are provided here courtesy of Thieme Medical Publishers