Direct approach to a traumatic intracavernous internal carotid artery aneurysm: a case report.

A traumatic intracavernous ICA aneurysm is a rare complication of head injury with skull base fracture. The hallmark of this condition is delayed, repeated, progressively worse and eventually fatal epistaxis. Inadequate treatment and delayed diagnosis are the major contributors to the high mortality. After epistaxis is controlled by anterior and posterior nasal packing, the patient should be investigated with carotid angiography and cross-flow study. In general, the acceptable procedure for this lesion is the trapping procedure by internal carotid artery ligation at the neck and clipping just proximal to the origin of the opthalmic artery, or by detachable balloon occlusion. However, Dolenc's technique of direct approach to cavernous sinus lesions makes it feasible to clip directly, as in this reported case.