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An Intracranial Intrasellar Kissing Carotid Arteries: A Case Report

Ohud Al Zaedi, Abdulaziz Alfaifi, Suresh Somannavar, Hayfaa Taher, Adel Saleh, Gibreil Khamis

We present a rare case of intracranial intrasellar kissing carotid arteries in a 68 years-old male in Saudi Arabia. This is a rare anomaly of the carotid arteries, where both internal carotid arteries deviate medially and touch each other near the midline within the sphenoid sinus or the sphenoid bone, including the sella. This can cause compression of the pituitary gland and presents as a hormonal insufficiency. The narrowing of the space due to pituitary compression may complicate Trans shpenoidal surgery.

This patient presented with generalised fatigue, weakness and weight loss. He was complaining of nausea, anorexia and weight loss. During the work up, he was submitted to pituitary MRI and found intracranial and intrasellar kissing carotid arteries.

As per our plan, conservative treatment started and hormonal replacement therapy continued for the pan hypopituitarism. He was advised to visit clinic for the regular follow up with frequent lab testing. The Surgeon was informed about this carotid anomaly to avoid possible complications during surgery.

The present case report highlights the importance of the internal carotid artery anomaly and its clinical relevance of investigating and identifying prior to the transsphenoidal surgery. If not detected before the surgery, this may complicate the surgery and prove fatal to the patient.