Endovascular treatment of a giant petrous internal carotid artery aneurysm. Case report and review of the literature.

Expansive aneurysms of the petrous internal carotid artery are rare. Compressive and thrombembolic neurological deficits and occasionally extradural haemorrhage in combination with a pulsatile tinnitus are most important and alarming symptoms. Due to its extradural location, subarachnoid haemorrhage does not occur. Treatment is indicated since rupture may be devastating and recurrent ischaemic attacks severely disabling. Because direct neurosurgical access to the petrous internal carotid artery is very difficult, treatments consists of parent vessel occlusion with or without extra-intracranial bypass construction. We present a case of a young man with a giant petrous artery aneurysm provoking a thrombembolic event which was treated successfully with proximal balloon occlusion of the internal carotid artery after a temporary balloon occlusion test.