Fig. 63.1
Dolichoectasia. (a, b) Axial T2-weighted MR images. (c) Maximum-intensity-projection (MIP) time-of-flight MR angiography. The intracranial internal carotid arteries appear ectatic, with marked tortuosity, in a 10-year-old boy with a diagnosis of Ehlers-Danlos syndrome
On MRI, asymptomatic unilateral ectasia of the ICA, in which the ICA comes in direct contact with the optic nerve but no visual loss occurs, has been reported in up to 70 % of patients. Bilateral optic nerve compression by the ICAs was seen in 12 % of patients. The diameter of the ICA was correlated with optic nerve compression [12].
Kissing carotid arteries can be assessed on noninvasive imaging including CT angiogram and MR angiograms (Fig. 63.2).
Fig. 63.2
Kissing internal carotid arteries. Axial MRI through the sellar region, showing significant bilateral dolichoectasia of the ICAs, also known as “kissing” ICAs (Adapted with permission from Sahin et al. [8])
63.3 Clinical and Surgical Management
Anomalies in the course and caliber of the ICA—especially kissing ICAs (Fig. 63.2)—can be a contraindication to various surgical approaches. Surgeons planning any operations in the sellar and suprasellar region must routinely and habitually study the anatomy and course of the ICA prior to any operation.
Patients with acromegaly require additional attention in surgical planning, as they are known to have fusiform dilatation and increased tortuosity of the ICAs [11, 13].
References
1.
2.
Fargen KM, Blackburn S. Surgical decompression for optic neuropathy from carotid artery ectasia: case report with technical considerations. World Neurosurg. 2014;82:239. e9–12.CrossRefPubMed
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