Peripheral Facial Paralysis and Bilateral Carotid Pseudoaneurysms of Petrous Localization: A Case Report

Abstract

Carotid pseudoaneurysms of petrous localization are rare. They are mostly due to trauma, tumoral or infectious diseases, or a result of iatrogenic complications after skull base surgery. Symptoms such as facial paralysis are exceptional and have rarely been described in the literature until now. We report the case of a 64-year-old woman, who developed left peripheral facial paralysis induced by two carotid pseudoaneurysms in their intrapetrous section. The treatment is endovascular, despite the high morbidity rate. She was first put on antiplatelet medications, before the left carotid aneurysm was bypassed thanks to a self-expanding pipeline-type stent with flow diversion. The left peripheral facial paralysis was due to the compression exerted by the left carotid aneurysm, probably a congenital malformation. The progressive palsy recovery was fist due to the aneurysmal thrombosis, then to the secondary fibrosis.

Keywords

Peripheral facial paralysis - carotid pseudoaneurysm - petrous localization - endovascular treatment - self-expanding stent

Publication History

Publication Date:
22 July 2011 (online)

• REFERENCES

• 1 Bergés C, Pollak A, Valavanis A, Fisch U. Gradual facial palsy and intrapetrous internal carotid aneurysm: a case report. Skull Base Surg 1993; 3 (03) 164-169
• 2 Cohen JE, Grigoriadis S, Gomori JM. Petrous carotid artery pseudoaneurysm in bilateral carotid fibromuscular dysplasia: treatment by means of self-expanding covered stent. Surg Neurol 2007; 68 (02) 216-220 discussion 220
• 3 Mori R, Murayama Y, Irie K. et al. Endovascular treatment of large petrous internal carotid artery aneurysm associated with chronic otitis media: case report. No Shinkei Geka 2006; 34 (04) 415-419
• 4 Brandt TW, Jenkins HA, Coker NJ. Facial paralysis as the initial presentation of an internal carotid artery aneurysm. Arch Otolaryngol Head Neck Surg 1986; 112 (02) 198-202
• 5 Sherman SC, Thompson T. Pontine hemorrhage presenting as an isolated facial nerve palsy. Ann Emerg Med 2005; 46 (06) 555
• 6 Guidetti D, Pisanello A, Giovanardi F, Morandi C, Zuccoli G, Troiso A. Spontaneous carotid dissection presenting lower cranial nerve palsies. J Neurol Sci 2001; 184 (02) 203-207
• 7 McCarron MO, Metcalfe RA, Muir KW. Facial nerve palsy secondary to internal carotid artery dissection. Eur J Neurol 2000; 7 (06) 723-725
• 8 Ray A, Lammie GA, Shone G, Hourihan MD, Vafidis J. Venous angioma of the facial nerve: a case report. Surg Neurol 2004; 61 (02) 198-200
• 9 Neimat JS, Hoh BL, McKenna MJ, Rabinov JD, Ogilvy CS. Aneurysmal expansion presenting as facial weakness: case report and review of the literature. Neurosurgery 2005; 56 (01) 190
• 10 Iglesias S, Hinojosa J, Esparza J, Muñoz A, Otero A. Congenital aneurysm presenting as peripheral facial paresis. Pediatr Neurosurg 2007; 43 (06) 504-506
• 11 Goodwin D. Differential diagnosis and management of acquired sixth cranial nerve palsy. Optometry 2006; 77 (11) 534-539
• 12 Griffith AJ, Terrell JE. Transsphenoid endoscopic management of petrous apex cholesterol granuloma. Otolaryngol Head Neck Surg 1996; 114 (01) 91-94
• 13 Veillona F, Ramos-Taboada L, Abu-Eid M, Charpiot A, Riehm S. Imaging of the facial nerve. Eur J Radiol 2010; 74 (02) 341-348
• 14 Roski RA, Spetzler RF, Nulsen FE. Late complications of carotid ligation in the treatment of intracranial aneurysms. J Neurosurg 1981; 54 (05) 583-587
• 15 Lylyk P, Miranda C, Ceratto R. et al. Curative endovascular reconstruction of cerebral aneurysms with the pipeline embolization device: the Buenos Aires experience. Neurosurgery 2009; 64 (04) 632-642 discussion 643-642 quiz N6
• 16 Pavlisa G, Ozretic D, Murselovic T, Pavlisa G, Rados M. Sole stenting of large and giant intracranial aneurysms with self-expanding intracranial stents-limits and complications. Acta Neurochir (Wien) 2010; 152 (05) 763-769