According to the ISUIA study published in Lancet in 2003, cavernous carotid aneurysms have been considered to have a lower risk of rupturing compared to aneurysms in other locations. However, as the size of the aneurysm increases, local mass effects could cause cranial nerve palsies.
This patient presented to an outside hospital with right CN III palsy and was diagnosed with a large right cavernous carotid aneurysm. A Pipeline Flex stent was placed at the outside hospital, and a 6-month post-op DSA at our institute showed complete occlusion of the aneurysm. Interestingly, probably due to the remaining mass effect of the aneurysm, causing high pressure at the cavernous sinuses, the venous phase of the DSA showed retrograde flow of the superior ophthalmic vein (blue arrow).
Red arrow: Right ophthalmic artery.