Port wine nevus associated with ipsilateral saccular aneurysms: treatment by intraarterial balloon trapping

A 21-year-old woman with a port wine nevus presented with ipsilateral monocular visual loss. A computed tomography scan of the brain revealed a round suprasellar mass. Angiography demonstrated aneurysm of the right external carotid artery, and petrous, cavernous, and giant ophthalmic internal carotid aneurysms. Four detachable balloons were deployed with arteriographic guidance, resulting in occlusion of the right carotid artery. The association of aneurysms and phakomatoses is discussed. The use of detachable balloons in the treatment of nonresectable aneurysms represents a safe and advantageous option. The use of detachable balloons for carotid occlusion has proven to be an effective modality in the treatment of giant supraclinoid and carotid-cavernous aneurysms. Giant intracranial aneurysms have been surgically treated with carotid ligation proximal to the aneurysm and by direct approach using microsurgical technique. In cases in which direct ligation is not possible balloon occlusion represents an effective alternative. This case illustrates treatment by carotid trapping performed entirely with intraarterial balloons. In addition the association of saccular aneurysms in a patient with a port wine facial nevus is reported.