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Hemorrhagic stroke
Case series
Reconstruction of the sphenoid sinus erosion or dehiscence after treatment of unruptured intracavernous aneurysms with flow diverter stents
  1. Tiago Lorga1,2,
  2. Silvia Pizzuto1,
  3. Oguzhan Coskun1,
  4. Alessandro Sgreccia1,
  5. Martino Cavazza1,3,
  6. Mohammad Habibur Rahman1,4,
  7. Georges Rodesch1,
  8. Federico Di Maria1,
  9. Arturo Consoli1,5
  1. 1Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, France
  2. 2Neuroradiology, Centro Hospitalar Universitário de Lisboa Central EPE, Lisboa, Portugal
  3. 3Diagnostic and Interventional Radiology, University Hospital Arcispedale Sant'Anna of Ferrara, Cona, Italy
  4. 4Interventional Neurology, National Institute of Neurosciences and Hospital, Sher-E-Bangla Nagar, Bangladesh
  5. 5Versailles Saint-Quentin-en-Yvelines University, Versailles, France
  1. Correspondence to Dr Tiago Lorga, Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, 92150, France; tiagomlorga{at}gmail.com

Abstract

Background Intracavernous carotid aneurysms (ICCAs) are rare, frequently asymptomatic, with a low rupture risk, which, however, can lead to life-threatening epistaxis. The aim of this study was to assess the effect of the treatment of asymptomatic ICCAs with flow diverters (FD) on sphenoid bone erosion or dehiscence in a selected cohort of patients.

Methods We retrospectively reviewed all asymptomatic ICCAs with sphenoid bone erosion or dehiscence detected on cone beam CT (CBCT) and treated with FD between December 2018 and December 2022. Patients were followed-up with CBCT and bone reconstruction was blindly evaluated by two interventional neuroradiologists and classified as unchanged, partial, or complete.

Results A total of 10 patients (women: 90%, mean age 58 years) treated with an FD for an asymptomatic ICCA with associated sphenoid bone erosion or dehiscence were included in this cohort. Sphenoid bone erosion was present in seven patients and dehiscence was observed in the remaining three. After treatment with FD, complete reconstruction of the sphenoid sinus wall occurred in seven cases, and partial reconstruction in two cases. Sphenoid bone erosion remained unchanged after treatment in only one patient.

Conclusions The decision to treat asymptomatic and unruptured ICCAs remains challenging due to their benign natural history and low hemorrhagic risk. The presence of sphenoid sinus erosion or dehiscence should not be overlooked since it could be considered as an indication for prophylactic treatment of life-threatening epistaxis. The mechanisms of bone erosion by the aneurysm and of reconstruction after treatment are still to be fully elucidated.

  • Aneurysm
  • Flow Diverter
  • Angiography
  • CT

http://dx.doi.org/10.1136/jnis-2023-020734

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    Footnotes

    • Contributors AC, SP, OC participated in the study design and conception, AS, TL, MHR, MC participated in data collection. FDM, GR, SP, OC, AS, AC made critical revisions and supervised manuscript drafting, with TL having ultimate responsibility for manuscript drafting. All the authors had access to and agreed on the final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.