Infectious aneurysms of the cavernous carotid artery.

We describe 3 patients who developed infectious aneurysms of the cavernous carotid artery. The aneurysms were due to sphenoidal sinusitis in two patie nts and due to endocarditis in one. The acute and septic onset of the caver nous sinus syndrome, suggested thrombophlebitis of the cavernous sinus in a il 3 patients. The diagnosis was established by magnetic resonance imaging and magnetic resonance angiography. Therapeutic internal carotid artery occ lusion was indicated for a fissuration of their aneurysm manifested (n = 3) by an episode of epistaxis (n = 2) and blood in sphenoid sinus (depicted b y MRI) in one case. We discuss the pathophysiology and management of bacter ial aneurysms of the cavernous carotid artery. Close clinical and imaging f ollow-up should be performed for patients under antibiotherapy. Selective a ngiography with therapeutic occlusion of the carotid artery is discussed in patients with persistence of symptoms or if clinical findings are suggesti ve of fissuration or if aneurysmal sac diameter increases on follow-up imag ing studies.