CT and MRI findings of sphenoid sinus internal carotid artery pseudoaneurysm: An important and challenging differential diagnosis for a skull base mass

2012 ◽  
Vol 67 (8) ◽  
pp. 815-820 ◽  
Author(s):  
R.R. Saket ◽  
S.W. Hetts ◽  
J.K. Tatum ◽  
C.M. Glastonbury
Keyword(s):  
Differential Diagnosis ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Sphenoid Sinus ◽  
Internal Carotid ◽  
Mri Findings ◽  
Artery Pseudoaneurysm ◽  
Ct And Mri

scholarly journals Endovascular plug for internal carotid artery occlusion in the management of a cavernous pseudoaneurysm with bifrontal subdural empyema: technical note

2017 ◽  
Vol 20 (3) ◽  
pp. 239-246
Author(s):  
Sunil Manjila ◽  
Gagandeep Singh ◽  
Obinna Ndubuizu ◽  
Zoe Jones ◽  
Daniel P. Hsu ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Sphenoid Sinus ◽  
Internal Carotid ◽  
Balloon Catheter ◽  
Arterial Injury ◽  
Technical Note ◽  
Subdural Empyema ◽  
Artery Pseudoaneurysm ◽  
The Right

The authors demonstrate the use of an endovascular plug in securing a carotid artery pseudoaneurysm in an emergent setting requiring craniotomy for a concurrent subdural empyema.They describe the case of a 14-year-old boy with sinusitis and bifrontal subdural empyema who underwent transsphenoidal exploration at an outside hospital. An injury to the right cavernous segment of the ICA caused torrential epistaxis. Bleeding was successfully controlled by inflating a Foley balloon catheter within the sphenoid sinus, and the patient was transferred to the authors’ institution. Emergent angiography showed a dissection of the right cavernous carotid artery, with a large pseudoaneurysm projecting into the sphenoid sinus at the site of arterial injury. The right internal carotid artery was obliterated using pushable coils distally and an endovascular plug proximally. The endovascular plug enabled the authors to successfully exclude the pseudoaneurysm from the circulation. The patient subsequently underwent an emergent bifrontal craniotomy for evacuation of a left frontotemporal subdural empyema and exenteration of both frontal sinuses. He made a complete neurological recovery.Endovascular large-vessel sacrifice, obviating the need for numerous coils and antiplatelet therapy, has a role in the setting of selected acute neurosurgical emergencies necessitating craniotomy. The endovascular plug is a useful adjunct in such circumstances as the device can be deployed rapidly, safely, and effectively.

Propionibacterium skull base osteomyelitis complicated by internal carotid artery pseudoaneurysm

2016 ◽  
Vol 127 (10) ◽  
pp. 2337-2339 ◽  
Author(s):  
Kathryn L. Kreicher ◽  
Jonathan L. Hatch ◽  
Shivangi Lohia ◽  
Ted A. Meyer
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Internal Carotid ◽  
Artery Pseudoaneurysm ◽  
Skull Base Osteomyelitis

Pitfalls during the Embolization and Evaluation after the Embolization for the Skull Base Meningiomas

1995 ◽  
Vol 8 (6) ◽  
pp. 252-257
Author(s):  
A. Nishio ◽  
K. Ohata ◽  
N. Tsuyuguchi ◽  
T. Gotoh ◽  
T. Ishiguro ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Internal Carotid ◽  
Serum Levels ◽  
External Carotid Artery ◽  
External Carotid ◽  
Preoperative Embolization ◽  
Mri Findings ◽  
Skull Base Meningiomas

Pitfall during the embolization and evaluation after the embolization for skull base meningiomas supplied by meningeal arteries of internal carotid artery (ICA) are reported. This study includes 15 cases of skull base meningiomas (two males and 13 females) that supplied by meningeal branches of internal carotid artery. The preoperative embolization was performed by these feeders. MRI findings and serum levels of C-reactive protein (CRP) after the embolization were examined. In ten patients among 15 patients the meningeal branches of ICA were dominant feeders. In ten patients out of 15 patients, the embolization from the meningeal branches of ICA was possible. Eight patients out of these ten patients were suffered from high fever and increase of serum level of CRP after the embolization. During the embolization for skull base meningiomas, the existence of collateral pathways between the ICA system and external carotid artery system were identified. The increase of serum levels of CRP might be recognized in the patients that effective embolization were performed.

Profuse epistaxis following sphenoid surgery: a ruptured carotid artery pseudoaneurysm and its management

2008 ◽  
Vol 123 (6) ◽  
pp. 692-694 ◽  
Author(s):  
D Biswas ◽  
A Daudia ◽  
N S Jones ◽  
N S McConachie
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Sphenoid Sinus ◽  
Internal Carotid ◽  
Rare Complication ◽  
Gain Control ◽  
Sinus Surgery ◽  
Unusual Complication ◽  
Subsequent Formation ◽  
Artery Pseudoaneurysm

AbstractObjective:We report a rare case of iatrogenic pseudoaneurysm of the internal carotid artery secondary to endoscopic sphenoid surgery.Method:The management of this unusual complication and a review of the literature are presented.Results:A 65-year-old woman presented with intractable epistaxis four days following endoscopic sphenoid sinus surgery. Initial, conservative measures were unsuccessful in controlling bleeding. The clinical picture of delayed, severe epistaxis after a sphenoid sinus exploration raised the possibility of injury to the internal carotid artery and subsequent formation of a false aneurysm. The patient's pseudoaneurysm was managed, without visualising it, by packing the sphenoid sinus (achieved by palpating 1 cm above the shoulder of the posterior choana) in order to gain control of the haemorrhage, followed by endovascular occlusion.Conclusion:An awareness of this rare complication is essential in order to manage this life-threatening condition efficiently.

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

2018 ◽  
Vol 15 (6) ◽  
pp. E84-E84 ◽  
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.

scholarly journals Delayed intranasal coil extrusion after internal carotid artery pseudoaneurysm embolization

2018 ◽  
Vol 25 (2) ◽  
pp. 139-143 ◽  
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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