J Cerebrovasc Endovasc Neurosurg.  2021 Mar;23(1):35-40. 10.7461/jcen.2021.E2020.06.002.

Delayed cranial nerve palsy after successful coil embolization in cavernous sinus lesion

• Park G
• Kim J
• Chang C
• Jung Y

• KMID: 2514336
• DOI: http://doi.org/10.7461/jcen.2021.E2020.06.002

Abstract

Cavernous sinus (CS) lesion is hard to access by surgical approach. With the development of endovascular technique, neurointerventional therapy is an alternative modality for CS lesions. This endovascular technique has been widely used for the past decade, avoiding the risks associated with surgical treatment. However, complications can still arise from coil embolization. Although immediate complication associate with embolic event or mass effect has been well described, but delayed (>1 year from treatment) nerve palsy after coil embolization is rare. We report two cases of delayed cranial nerve palsy after successful endovascular coil embolization in CS lesion.

Keyword

Cavernous sinus, Embolization, Delayed nerve palsy

Figure

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  Fig. 1. Case 1, A 61-year-old woman with delayed incomplete Horner’s syndrome beginning 19 months following coiling of a left ICA aneurysm. (A, B) Preoperative angiography demonstrated the incidental unruptured aneurysm of the left cavernous ICA. (C, D) In postoperative angiography, complete coiling was checked. (E, F) After 19 months, follow-up angiography was done and there was no interval change on coiling site. ICA, internal carotid artery.

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  Fig. 2. Case 1, (A) Preoperative T2-weighted axial MRI reveals an aneurysm arising from the cavernous portion of the left ICA. (B) 19 months later, postoperative T2-weighted axial MRI shows heterogeneous signal intensity from within the aneurysm, consistent with coil packing. (C, D) Postoperative T1-weighted axial MRI shows discontinuity of left CS outer wall (arrow). MRI, magnetic resonance imaging; ICA, internal carotid artery; CS, cavernous sinus.

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  Fig. 3. Case 2, A 50-year-old woman with delayed right 6th nerve palsy beginning 38 months after coil embolization of CCF. (A, B) Preoperative angiography was done and dural type CCF. (C, D) In postoperative angiography, CCF and shunting flow was not checked. (E, F) After 38 months, follow-up angiography was done and there was no interval change on coiling site. CCF, carotid cavernous fistula.

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  Fig. 4. (A) Preoperative T2-weighted axial MRI shows the signal voiding on right CS. (B) preoperative MR source image shows abnormal signal flow on the right CS. (C) 38 months later, postoperative T2-weighted axial MRI shows some mixed signal intensity lesion suggesting inflammatory reaction or thrombosis (arrow) around CS and prepontine/superior cerebellopontine cistern. (D) Postoperative MR source image reveals complete obliteration of CCF. MRI, magnetic resonance imaging; CS, cavernous sinus; CCF, carotid cavernous fistula.

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