Giant aneurysm of the carotid siphon in patient with latent neurosyphilis, treated with high-flow extraintracranial bypass and trapping of the internal carotid artery

Giovanni Mancini, Ospedale G.B. Grassi
Giovanni Pauletti, Ospedale G.B. Grassi
Lorenzo Sinibaldi, Ospedale G.B. Grassi
Francesca Muzzi, Ospedale G.B. Grassi
Antonio Santoro, Sapienza Università di Roma
Emilio Passacantilli, Sapienza Università di Roma
Giampaolo Cantore, Sapienza Università di Roma


In a 44 year-old male patient, admitted to the hospital for a generalized seizure with prolonged psychomotor slowing, a positivity for serological markers of syphilis and a large-necked giant aneurysm of the left intracavernous carotid siphon was diagnosed by means of CT-scan, MRI and Angiography, with partial thrombosis inside the aneurysmal sac. The large volume and location of the aneurysm made the direct clipping of the lesion difficult. It was therefore decided a more conservative neurosurgical approach, consisting in the clipping of the supraclinoid tract of the siphon and the emptying of the aneurysm, after revascularization by means of a high-flow bypass from the internal carotid to the middle cerebral artery (temporal branch) with a graft of saphenus vein, to supply an adequate perfusion to the carotid territory. The relationship between possible latent syphilitic infection and the pathogenesis of the giant aneurysm is discussed, as a possible meningovascular form of neurolues.