case_images: PMC11220115_01
case_images: The preoperative evaluation and surgical process in Case 1. (A) The timeline of management in case 1. (B) Preoperative CT of the head demonstrates lateral wall of sphenoid sinus cavity that protrudes into the optic canal (arrow). (C) Postoperative CTA shows enhancement of the central patent portion of the pseudoaneurysm that protrudes into the sphenoid sinus cavity (arrow). (D) A pseudoaneurysm is visualized arising from the ophthalmic artery in the early arterial phase of ophthalmic artery after contrast injection. (E) 3D reconstruction of DSA demonstrates the irregular pseudoaneurysm with the feature of re-rupture (arrow). (F) The angiogram obtained after endovascular treatment demonstrates complete occlusion of the pseudoaneurysm. Onyx was infused into the ethmoid sinus cavity (arrowhead). (G) The surgical field of cerebrospinal fluid leak repair demonstrates the residual pulsation of embolized pseudoaneurysm (arrow).
case_images: fneur-15-1382793-g001.jpg
case_images: PMC11220115_01_fneur-15-1382793-g001.jpg
case_images: fig1
case_images: A 35 year-old male patient was transferred to our hospital due to right eye visual loss after head trauma for 6 days (Figure 1A). Head computed tomography (CT) demonstrated fractures of the sphenoid bone and a slim right frontal epidural hematoma (Figure 1B). The patient awoke without additional neurological impair, and postoperative CTA and following cerebral angiography revealed a pseudoaneurysm arising from the right ophthalmic artery that intruding into the ethmoid sinus (Figures 1C-E). A small amount of glue was introduced into the ethmoid cavity during the procedure (Figure 1F). Pulsating movements beneath the skull base indicated the presence of the embolized pseudoaneurysm (Figure 1G).
case_images: PMC11220115_02
case_images: The preoperative evaluation and surgical process in Case 2. (A) The timeline of management in case 2. (B) Preoperative CT of the head demonstrates lateral wall of sphenoid sinus cavity in the left that protrudes into the optic canal (arrow). (C) Postoperative CTA shows enhancement of the central patent portion of the pseudoaneurysm that protrudes into the sphenoid sinus cavity (arrow). (D) The left internal carotid injection of the contrast demonstrates a pseudoaneurysm arising from ICA. (E) 3D reconstruction of DSA demonstrates the irregular pseudoaneurysm with the feature of re-rupture (arrow). (F) The angiogram obtained after endovascular treatment demonstrates complete occlusion of the pseudoaneurysm with coils. (G) Post-embolization angiogram demonstrates complete occlusion of the pseudoaneurysm cavity (arrow).
case_images: fneur-15-1382793-g002.jpg
case_images: PMC11220115_02_fneur-15-1382793-g002.jpg
case_images: fig2
case_images: A 29 year-old male patient was transferred to our hospital following an 8 day history of visual loss after a 3 meter fall-induced head injury (Figure 2A). CT revealed multiple skull base fractures, including those involving the left sphenoid, frontal, and orbit bones, as well as narrowing of the left optic nerve canal (Figure 2B). CTA showed no evidence of contrast extravasation or pseudoaneurysm. Emergency postoperative CT angiography revealed a dissected pseudoaneurysm originating from the ophthalmic segment of the left internal carotid artery protruding into the sphenoid sinus (Figure 2C). Subsequently, patient underwent emergent cerebral angiography, which revealed a 5.7 x 8.8 cm ophthalmic segment aneurysm of the left internal carotid artery (Figures 2D,E). Additional coils (3 x 10 mm and 1.5 x 2 mm) were deployed into the cavity before final closure of the aneurysm opening (Figure 2F). Post-procedural imaging confirmed tight coiling of the aneurysm with no detectable bloodstream flow within the sac (Figure 2G).