• Shravan Atluri, Mario Zanaty, Anthony Guidotti, Ethan Cline, Erin Reilly, and Ondrej Choutka.
• Saint Alphonsus Medical Group, Trinity Healthcare System, Boise, ID; Idaho College of Osteopathic Medicine, Meridian, ID. Electronic address: satluri@s.icom.edu.
• World Neurosurg. 2024 Nov 20.

AbstractCavernous Carotid Aneurysms are typically small, asymptomatic, and often do not require treatment. We present the case of a 59-year-old woman, a three-pack-a-day smoker, who presented with the primary complaint of left retro-orbital pain, left complete ophthalmoplegia, left-sided blindness, and right abducens palsy. Imaging revealed a giant right cavernous carotid aneurysm, which had expanded to the contralateral cavernous sinus wall as well as superiorly through the diaphragm sellae. The patient had previously undergone a balloon test occlusion, which was not passed on clinical grounds and resulted in decreased perfusion as well as symptoms of ipsilateral cavernous sinus syndrome and was non adherent to dual anti-platelet therapy. Additionally, the aneurysm had rapidly enlarged over a three-month period, due to these considerations an endonasal approach with clipping and reconstruction was chosen. Patient consent was obtained, and the patient underwent an expanded endoscopic endonasal approach for clipping of a giant cavernous carotid aneurysm with reconstruction of the internal carotid artery. Post-operative CTA confirmed placement of the clips and patency of the vessel. At short term follow up, the patient's trigeminal pain had successfully resolved and she had retained vision in the right eye. This case demonstrates the feasibility of expanded endonasal approaches in managing this challenging pathology.Copyright © 2024. Published by Elsevier Inc.

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