How do you approach interval monitoring of cavernous carotid aneurysms?

Cavernous carotid aneurysms are typically extradural in location. While they carry some rupture risk depending on size and morphology, they are less likely to cause SAH and more likely to hemorrhage into the cavernous sinus (e.g., CCF). Although any intracranial hemorrhage is concerning, bleeding into the cavernous sinus generally carries a lower mortality risk than SAH.

It is reasonable to initially assess with non-invasive imaging (CTA/MRA), as many cavernous carotid aneurysms are incidentally found via these modalities during workup for other issues. I prefer CTA because it is a contrasted study, which offers greater clarity in visualizing vascular distributions. However, both CTA and MRA can be affected by artifacts in the region of the...