Propionibacterium skull base osteomyelitis complicated by internal carotid artery pseudoaneurysm

AbstractObjectiveCarotid artery aneurysm is a potentially fatal complication of skull base osteomyelitis. It is important to know the warning signs for this complication, as early diagnosis is of great importance. This report aimed to determine whether the pattern of cranial nerve involvement may predict the occurrence of aneurysm involving the internal carotid artery in skull base osteomyelitis.MethodsTwo diabetic patients with skull base osteomyelitis were incidentally diagnosed with pseudo-aneurysm of the petrous internal carotid artery on follow-up magnetic resonance imaging. They presented with lower cranial nerve palsy; however, facial nerve function was almost preserved in both cases. Computed tomography angiography confirmed aneurysms at the junction of the horizontal and vertical segments of the petrous carotid artery.ResultsInternal carotid artery trapping was conducted using coil embolisation. Post-coiling magnetic resonance imaging demonstrated no procedure-related complications. Regular follow up has demonstrated that patients’ symptoms are improving.ConclusionOne should be mindful of this potentially fatal complication in skull base osteomyelitis patients with lower cranial nerve palsies, with or without facial nerve involvement, especially in the presence of intracranial thromboembolic events or Horner's syndrome.

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Eikenella Corrodens and Streptococcus anginosus co-infection causing skull base osteomyelitis and internal carotid artery lesion

IDCases ◽

10.1016/j.idcr.2020.e00740 ◽

2020 ◽

Vol 20 ◽

pp. e00740

Author(s):

Kishan Patel ◽

Connie Park ◽

Zain Memon ◽

Nazish Ilyas

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Skull Base ◽

Internal Carotid ◽

Eikenella Corrodens ◽

Skull Base Osteomyelitis ◽

Streptococcus Anginosus

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Skull Base Osteomyelitis Complicated by Petrous Internal Carotid Artery Blowout

Ear Nose & Throat Journal ◽

10.1177/0145561320907164 ◽

2020 ◽

pp. 014556132090716 ◽

Cited By ~ 1

Author(s):

Rachel E. Weitzman ◽

Anuraag S. Parikh ◽

Shekhar K. Gadkaree ◽

C. Eduardo Corrales

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Skull Base ◽

Internal Carotid ◽

Clinical Laboratory ◽

Sinus Thrombosis ◽

The Elderly ◽

Invasive Infection ◽

Level Of Evidence ◽

Skull Base Osteomyelitis

Skull base osteomyelitis (SBO) is an invasive infection of the external auditory canal, with involvement of the skull base, typically in the elderly diabetic population. Diagnosis may be challenging, as it requires a combination of clinical, laboratory, and radiographical findings. The mainstay of treatment is long-term antibiotic therapy, but surgical debridement of the temporal bone may be necessary in refractory cases. Commonly reported complications include cranial neuropathies, meningitis, temporal lobe abscess, and dural venous sinus thrombosis. A rare and life-threatening complication of SBO is petrous internal carotid artery (ICA) blowout, which has been described as presenting with bleeding from the ear. Here, we describe the case of a 77-year-old woman with SBO complicated by a petrous ICA blowout, which presented with fulminant epistaxis. To our knowledge, this is the second reported case of a massive hemorrhage from a petrous ICA blowout secondary to SBO and the first presentation with massive epistaxis. We present this case to raise awareness of this potential impending complication in patients with SBO and recommend consideration of this etiology when assessing patients with massive epistaxis in the appropriate clinical setting. Level of evidence: III

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Large Traumatic Skull Base Internal Carotid Artery Pseudoaneurysm managed With Endovascular Flow Diversion: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opy119 ◽

2018 ◽

Vol 15 (6) ◽

pp. E84-E84 ◽

Cited By ~ 1

Author(s):

Gary Rajah ◽

Richard Justin Garling ◽

Leonardo Rangel-Castilla

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Skull Base ◽

Internal Carotid ◽

Flow Diversion ◽

Artery Pseudoaneurysm ◽

Traumatic Injuries ◽

Carotid Canal ◽

Initial Injury ◽

Flow Stasis

Abstract We present a case of a traumatic skull base internal carotid artery (ICA) pseudoaneurysm treated with endovascular flow diversion stenting. The patient was a 27-year-old male who was involved in a motorcycle accident suffering multiple traumatic injuries including a large skull base fracture that extended through the carotid canal. Computed tomography angiography revealed a 2-cm right ICA pseudoaneurysm. Once the patient was stable, a digital subtraction angiography demonstrated enlargement of the pseudoaneurysm. After his other injuries were addressed by trauma and orthopedic surgery, at day 9 after his initial injury, the patient was loaded with aspirin and clopidrogel in preparation for stent reconstruction of his ICA injury. Under conscious sedation and systemic heparinization, the patient underwent endovascular reconstruction of the large pseudoaneurysm using telescoping flow diversion stents. Immediate intra-aneurysm flow stasis was observed. No procedure-related complications occurred. The patient did well and at last follow-up remained neurologically intact.

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Delayed intranasal coil extrusion after internal carotid artery pseudoaneurysm embolization

Interventional Neuroradiology ◽

10.1177/1591019918805151 ◽

2018 ◽

Vol 25 (2) ◽

pp. 139-143 ◽

Cited By ~ 5

Author(s):

Stanimir Sirakov ◽

Adriana Panayotova ◽

Alexander Sirakov ◽

Krasimir Minkin ◽

Hristo Hristov

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Skull Base ◽

Internal Carotid ◽

Endovascular Embolization ◽

Fistula Formation ◽

Carotid Artery Injury ◽

Artery Pseudoaneurysm ◽

Artery Injury ◽

Flow Diverter Stent

Internal carotid artery (ICA) injury is a rare but potentially life-threatening complication of skull base and neck surgery. Although usually manifested by massive intraoperative haemorrhage, impairment of the ICA might go unnoticed and result in formation of a pseudoaneurysm, causing delayed bleeding. Often additional complications are observed such as thrombosis, spasm, embolism or carotico-cavernous fistula formation. The risk of carotid artery injury in aggressive endonasal skull base surgical interventions ranges from 1% to 9%. Digital subtracted angiography remains the gold standard for evaluation of patients with iatrogenic carotid artery injury as it allows for endovascular treatment at the time of the procedure. Endovascular embolization is currently the preferred method for treating ICA pseudoaneurysms and a successful alternative to the surgical approach. Even though endovascular approaches are considered the safer option, delayed complications have been registered, such as endovascular coil extrusion and migration, which increases the risk of further episodes of bleeding. We present our experience with late coil extrusion in a patient who was previously treated with flow diverter stent and coiling for iatrogenic ICA pseudoaneurysm.

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