Türk Nöroşirürji Dergisi 2008 , Vol 18 , Num 2
The Occurrence of Granulomatous Reaction Following Coil (Treatment): A Case Report
Vaner KÖKSAL1, Ahmet MENKÜ2, Halil DÖNMEZ3, Ali KURTSOY4, İ. Suat ÖKTEM5
1,2,4,5 Erciyes Üniversitesi Tıp Fakültesi, Nöroşirurji Anabilim Dalı, Kayseri, Türkiye
3 Erciyes Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Kayseri, Türkiye
A51-year-old female patient was admitted to our clinic with the complaint of diplopia, lasting 4-5 months and occurring in left-gazes. Paralysis of the left sixth nerve was found in her neurological examination. Her radiological examination revealed a saccular aneurysm of the internal carotid artery, located in the cavernous sinus and measuring 3x2.5cm in size. The aneurysm lumen was occluded by coil embolization. In the repeating radiological investigations of the patient who had left hemiparesis and day-time hypersomnolence which appeared progressively after postop first month, a prominent inflammation within the left cavernous sinus, infarct near the brainstem and an edema peripheral to the aqueduct were detected. A ventriculoperitoneal shunt was placed due to the occurrence of hydrocephalus at the follow-up period. The occurrence of granulomatous inflammatory reaction within the cavernous sinus following endovascular coil embolization of intracavernous carotid artery aneurysm is a rare complication that we have not encountered in the literature. The cause of this case could not be identified, but it is thought that this reaction could result from contrast media or coil particle infiltrating into the cavernous sinus or basal cisterns when performing angiography. A literature review was therefore also carried out in parallel to the consepts outlined above. Anahtar Kelimeler : Idiopathic granulomatous hypophysitis, Intracavernous internal carotid artery aneurysm, Cavernous sinus granulomatous reaction, Endovascular treatment of cavernous sinus carotid aneurysm complications, Tolosa-hunt syndrome