Aneurisma carotido-cavernoso bilaterale: Follow-up di 10 anni

A 73 years old woman with hypertension and cronic headache was first seen at 63 y. when she developed acute onset of the right 6th nerve palsy, resolving over two months. At 68 y. she was admitted to our departement for transient deficit of the left 6th nerve with headache, while visus and papilla were normal. Routine blood chemistries, thyroid function tests, ECG, EEG, Ultrasound Examination of the extracranial arteries, were all normal. Cranial C.T. Scan, MRI, MRA showed two specular aneurysms of the cavernous carotid artery. Since the age of 69 she suffered progressive worsening of the visual function of her right eye: at first an enlarging of the blind spot with peripheral visual fields restriction, then central scotoma up to the extreme of total blindness (1/20 with optic atrophy). Angiography: giant aneurysm of the right cavernous carotid and 'large' aneurysm of the left one. The cavernous carotid artery is one of the sites in which endovascular techniques are preferred due to the difficulty in the surgical approach. Endovascular treatment was not performed because of the high risk of intracranial haemorrhage; this conservative choice was good as it's confirmed by the natural history: during the last three years she experienced neither worsening nor acute vascular events.