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Abstract
Mycotic aneurysms may arise in the setting of many local or systemic infections. Those
of the intracranial circulation are especially worrisome due to their potential to
compress vital neural structures and their propensity for rupture with consequent
hemorrhage. Mycotic aneurysms of the intracavernous internal carotid artery (ICA)
represent an exceedingly rare clinical entity, described in less than fifty published
cases. Typically presenting as a cavernous sinus syndrome with signs and symptoms
of the underlying infection, they are often missed initially, with diagnosis and treatment
commencing for the triggering infection or confused with cavernous sinus thrombophlebitis,
which may be additionally coexistent, confounding timely diagnosis of the aneurysmal
disease. Compared to non-mycotic aneurysms of the intracavernous ICA, which typically
have a benign course, the infectious etiology of the mycotic variety increases their
tendency to rupture, precludes surgical clipping as a viable treatment option, and
requires institution of prolonged antibiotic therapy prior to definitive intervention.
Their critical location, friability, and propensity to occur bilaterally result in
an unpredictable risk of rapid neurological decline and death, making the timing and
specific nature of treatment a unique dilemma facing the treating physician. This
review seeks to discuss the natural history of and management strategies for mycotic
aneurysms of the intracavernous ICA with special emphasis on the role, safety, and
efficacy of endovascular therapies.