Bone Dehiscence of the Internal Carotid Arteries: Treatment Recommendation
No treatment is required for asymptomatic bone dehiscence of the internal carotid arteries with exposure into the sphenoid sinuses, as this represents an anatomical variant that is clinically significant only for presurgical planning. 1
Clinical Significance
This finding is stable and unchanged from prior imaging, which confirms it is a congenital anatomical variant rather than an acquired pathologic process. 1
Key Points About ICA Dehiscence:
Bone dehiscence overlying the internal carotid arteries within the sphenoid sinuses is a recognized anatomical variant that occurs in 2.7-3.6% of the population and requires no intervention in asymptomatic patients. 2, 3
The primary clinical relevance is for presurgical assessment if endoscopic transsphenoidal surgery is ever planned, as this represents a critical surgical landmark that must be identified preoperatively to prevent catastrophic vascular injury. 1
High-resolution CT without contrast effectively demonstrates bony canal anatomy and dehiscences, which is exactly what has been documented in this case. 4
When Treatment Would Be Indicated
Treatment becomes necessary only in specific pathologic scenarios, none of which apply to this stable anatomical variant:
Active sphenoid sinusitis with vascular complications: Aggressive infection in the setting of ICA dehiscence can rarely cause perivascular inflammation leading to arterial stenosis, occlusion, or thrombosis requiring urgent medical and potentially surgical intervention. 5, 6
Symptomatic aneurysm formation: Giant petrous ICA aneurysms with bone erosion presenting with epistaxis or cranial nerve palsies require endovascular or surgical treatment. 7
Planned transsphenoidal surgery: The dehiscence must be carefully mapped and avoided during any endoscopic approach to the sella or skull base. 1
Common Pitfalls to Avoid
Do not confuse stable anatomical variants with pathologic processes requiring intervention—the key distinguishing feature is stability on serial imaging and absence of symptoms. 1
Do not order unnecessary follow-up imaging for stable asymptomatic dehiscence, as this provides no clinical benefit and exposes the patient to radiation without changing management. 4
Ensure documentation is available if the patient ever requires sinus surgery or transsphenoidal pituitary surgery, as surgeons must be aware of this variant anatomy preoperatively to prevent ICA injury. 1