ACR Codes: 12.122
A portion of the internal carotid artery (the carotid 'siphon') normally travels within the venous cavernous sinus, on either side of the sphenoid bone and pituitary fossa. However, the position of the "cavernous carotid" can be quite variable, with medial displacement into the pituitary fossa and/or into the sphenoid sinus.
One important variant is the intrasellar carotid, another is the "kissing" carotid - where both cavernous carotid arteries deviate medially and touch each other near the midline within the sphenoid bone or the sphenoid sinus.
These anomalies are particularly important since they may cause or mimic pituitary disease. They also may complicate transphenoidal surgery.
Reference(s): 1: Neurosurg Rev 1998;21(4):281-3
"Kissing" bilateral large carotid-ophthalmic aneurysms. A case report.
Date I, Ogihara K, Tamiya T, Ohmoto T
Department of Neurological Surgery, Okayama University Medical School, Japan.
A case of unruptured bilateral large carotid-ophthalmic aneurysms, which appear
to be adjoining and "kissing" each other when visualized by three-dimensional
computed tomographic angiography (3-D CTA), is reported. Although bilateral
carotid-ophthalmic aneurysms are not rare, bilateral large ones are quite rare,
and direct imaging of "kissing aneurysms" of this portion has not been reported.
Since 3-D CTA is becoming a useful tool for the diagnosis of cerebral aneurysms,
we propose that these and similar bilateral large carotid-ophthalmic aneurysms
are good candidates for the term "kissing aneurysms".
"Kissing aneurysms" of the internal carotid artery.
Komiyama M, Yasui T, Tamura K, Nagata Y, Fu Y, Yagura H
Department of Neurosurgery, Osaka City General Hospital.
Five patients with kissing aneurysms (adherent internal carotid-posterior
communicating artery and ipsilateral internal carotid-anterior choroidal artery
aneurysms) are reported. There was female predominance and the subarachnoid
hemorrhage was commonly due to rupture of the proximal posterior communicating
artery aneurysm. Despite the demonstration of angiographic cleavage, the two
aneurysms adhere to each other, which makes surgical dissection difficult.
Meticulous dissection of the aneurysmal necks and preservation of the blood flow
in the anterior choroidal artery are of vital importance.
Kissing intrasellar carotid arteries in acromegaly: CT demonstration.
Sacher M, Som PM, Shugar JM, Leeds NE
Acromegaly is a disease with protean manifestations that are well described in
the literature. One finding infrequently encountered is aneurysmal dilatation of
the internal carotid arteries and their branches. A case is presented, with CT
documentation, in which the enlarged cavernous portions of the internal carotid
arteries prolapsed into the sella turcica and enlarged it. Frontal bossing,
frontal sinus enlargement, a dense cortical calvarium, prominent inion, and
proptosis secondary to extraocular muscular enlargement were findings also
present in this patient. The sella CT appearance has brought the term "kissing
intrasellar arteries" to mind to suggest the diagnosis.