“Giant Pneumoaneurysm” after Combined Internal Carotid Artery Occlusion and Extracranial-Intracranial Anastomosis

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Abstract
A patient with a giant aneurysm of the internal carotid artery (ICA) was treated by combined ICA occlusion in the neck and superficial temporal artery to middle cerebral artery anastomosis. Six months after complete closure of the ICA, the patient had episodes of nasal discharge mixed with dark red, old blood. Computed tomographic scan demonstrated that the lumen of the giant aneurysm was filled with a large amount of air, which communicated with the nasal cavity. Not finding a similar case in the literature, we named this entity “giant pneumoaneurysm.” After direct operation, the giant pneumoaneurysm collapsed. This unusual complication may be due to a decrease of blood supply to the aneurysmal wall through the vasa vasorum.

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