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