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Aneurysms arising from the intracavernous carotid artery account for 3–5% of all intracranial aneurysms. Bilateral intracavernous carotid artery aneurysms are rare, and there are few reported cases that have been treated surgically. Here, we present the case of a 65-year-old woman with bilateral giant and large aneurysms, who was successfully treated with surgery for bilateral aneurysms. The patient presented with progressive left oculomotor and abducens nerve palsies, and magnetic resonance imaging (MRI) showed bilateral intracavernous mass lesions. Cerebral angiography revealed left giant and right large aneurysms at the intracavernous carotid artery. As a treatment for the symptomatic left aneurysm, balloon test occlusion (BTO) of the left internal carotid artery (ICA) was performed using O gas positron emission tomography (PET). The PET study during the BTO showed slightly decreased cerebral blood flow (CBF) in the left hemisphere, without any neurological symptoms. Therefore, left ICA proximal ligation with low-flow bypass was performed. Just after the treatment, thrombosis of the aneurysm began, and the left cranial nerve palsies gradually improved. Three months after the surgery for the left aneurysm, the right aneurysm was treated by using endovascular coil embolization with a stent assist. The postoperative course was uneventful, and the PET study performed 6 months after surgery showed normal CBF, even in the left hemisphere. Bilateral intracavernous carotid artery aneurysms are rare, and surgical treatment is controversial because there is no strict indication for the treatment. However, surgical treatment for patients with progressive symptoms should be considered carefully.

A Case of Bilateral Intracavernous Carotid Artery Aneurysms Treated by Using Parent Artery Occlusion with Bypass and Endovascular Therapy