Cavernous sinus embolisation prior to removal of penetrating foreign body in a 6-year-old child

2020 ◽  
Vol 13 (12) ◽  
pp. e237301
Author(s):  
Kartik D Bhatia ◽  
Heath French ◽  
Gemma Olsson ◽  
Krishna Tumuluri
Keyword(s):  
Foreign Body ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Arterial Injury ◽  
Balloon Occlusion ◽  
Parent Vessel ◽  
Intraoperative Bleeding ◽  
Temporary Balloon Occlusion

Transorbital penetrating foreign bodies are extremely rare in children and may penetrate the cavernous sinus or the underlying internal carotid artery. Parent vessel sacrifice and temporary balloon occlusion are feasible options for managing arterial injury during removal of the foreign body. Even in the absence of arterial injury, the ophthalmologist may encounter significant bleeding from the cavernous sinus deep in their operative field that is difficult to control. We present a case of a 6-year-old child with a stick penetrating the left superior orbit to enter the cavernous sinus but sparing the internal carotid artery. We describe the first reported experience of prophylactic coil embolisation of the cavernous sinus to minimise intraoperative bleeding during transorbital removal of a foreign body with an excellent clinical outcome.

scholarly journals Rare Clinical Onset of Nontraumatic Intracavernous Aneurysm of the Internal Carotid Artery: A Diagnostic and Therapeutic Challenge

2020 ◽  
Author(s):  
Enzo Emanuelli ◽  
Maria Baldovin ◽  
Claudia Zanotti ◽  
Sara Munari ◽  
Luca Denaro ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Arterial Injury ◽  
Sphenoidal Sinus ◽  
Therapeutic Challenge ◽  
Cavernous Sinus Syndrome ◽  
Sellar Lesions ◽  
Risk Of Rupture

AbstractWhile the so-called pseudoaneurysms can result from arterial injury during trans-sphenoidal surgery or after a trauma, spontaneous aneurysms of cavernous–internal carotid artery (CICA) are rare. Symptoms vary and the differential diagnosis with other, more frequent, sellar lesions is difficult. We describe three cases of misdiagnosed CICA spontaneous aneurysm. In two cases the onset was with neuro-ophthalmological manifestations, classifiable as “cavernous sinus syndrome.” The emergency computed tomography scan did not show CICA aneurysm and the diagnosis was made by surgical exploration. The third patient came to our attention with a sudden severe unilateral epistaxis; endonasal surgery revealed also in this case a CICA aneurysm, eroding the wall and protruding into the sphenoidal sinus. When the onset was with a cavernous sinus syndrome, misdiagnosis exposed two patients to potential serious risk of bleeding, while the patient with epistaxis was treated with embolization, using coils and two balloons. Intracavernous nontraumatic aneurysms are both a diagnostic and therapeutic challenge, because of their heterogeneous onset and risk of rupture, potentially lethal. Intracavernous aneurysms can be managed with radiological follow-up, if asymptomatic or clinically stable, or can be surgically treated with endovascular or microsurgical techniques.

scholarly journals Balloon Test Occlusion for an Option to Decide Whether Simple ICA Ligation is Better Option than Trapping and High Flow Bypass of The Giant ICA Cavernous Aneurysm

2017 ◽  
Vol 14 (2) ◽  
pp. 32-35
Author(s):  
Saujanya Rajbhandari ◽  
Pravesh Rajbhandari ◽  
Pranaya Shrestha ◽  
Basant Pant ◽  
Anish Neupane
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Cross Flow ◽  
Balloon Occlusion ◽  
High Flow ◽  
Aneurysm Neck ◽  
Balloon Test Occlusion ◽  
Therapeutic Occlusion ◽  
Temporary Balloon Occlusion

Balloon Test occlusion (BTO) is a preoperative angiographic test used to estimate the risk of stroke after permanent therapeutic occlusion of an internal carotid artery (ICA) involved by aneurysms. Temporary balloon occlusion at the cavernous ICA aneurysm neck was performed in an attempt to assess the adequacy of cross flow from the opposite ICA. Adequate fl ow following BTO are preferred to have simple ICA ligation and incase of those who did not pass BTO trapping and high flow bypass is preferred .We have done Right ICA Ligation on our case report.Nepal Journal of Neuroscience, Vol. 14, No. 2,  2017 Page:32-35

Giant petrous carotid aneurysm: persistent epistaxis despite internal carotid artery ligation

2008 ◽  
Vol 122 (8) ◽  
Author(s):  
H Singh ◽  
J Thomas ◽  
W L E Hoe ◽  
D S Sethi
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Imaging Techniques ◽  
Balloon Occlusion ◽  
Petrous Apex ◽  
Carotid Angiography ◽  
Parent Vessel ◽  
Artery Ligation ◽  
Carotid Artery Ligation

AbstractObjectives:We report a rare case of giant petrous carotid aneurysm.Method:Case report and a review of the literature regarding treatment options for such aneurysms.Results:A 30-year-old man presented with epistaxis, headaches and visual disturbance. Definitive diagnosis was achieved by non-invasive imaging techniques, including magnetic resonance angiography and carotid angiography. Carotid angiography demonstrated a giant petrous carotid aneurysm effacing the petrous apex. The aneurysm was obliterated by internal carotid artery ligation, following successful tolerance of the balloon occlusion test. However, despite internal carotid artery ligation, this patient continued to have minor episodes of epistaxis.Conclusion:Some aneurysms are too large to be treated with endovascular occlusion techniques; in such cases, ligation of the parent vessel is indicated. However, our patient continued to experience persistent, mild epistaxis despite internal carotid artery ligation, as a result of the reperfusion phenomenon.

Temporary Balloon Occlusion of the Cavernous Carotid Artery for Removal of an Orbital and Intracranial Foreign Body: Case Report

Neurosurgery ◽  
2004 ◽  
Vol 55 (5) ◽  
pp. E1240-E1243 ◽  
Author(s):  
Edwin J. Cunningham ◽  
Barbara Albani ◽  
Thomas J. Masaryk ◽  
Peter A. Rasmussen
Keyword(s):  
Foreign Body ◽  
Carotid Artery ◽  
Cavernous Sinus ◽  
Balloon Occlusion ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
Angiography Suite ◽  
Cavernous Carotid Artery ◽  
Temporary Balloon Occlusion

Abstract OBJECTIVE AND IMPORTANCE: We describe the first reported use of temporary balloon occlusion of the cavernous internal carotid artery for controlled removal of a foreign object from the cavernous sinus. This endovascular approach may be an alternative to craniotomy in highly selected cases. CLINICAL PRESENTATION: A 34-year-old incarcerated male attempted suicide by stabbing the earpiece of his glasses through his right orbit into the intracranial compartment. He presented with complete ophthalmoplegia. The earpiece traversed the cavernous sinus, penetrating its posterior wall to enter the perimesencephalic cistern and cerebellum. Angiography demonstrated a small direct carotid-cavernous fistula. INTERVENTION: Removal of the foreign body was performed under general anesthesia in the angiography suite with the operating room on standby. Nondetachable and detachable balloons were inflated in the cavernous carotid artery to provide vascular control while the foreign body was withdrawn from the cranium at the orbit. Follow-up angiographic runs with the balloons deflated revealed minimal arteriovenous shunting, which disappeared on subsequent studies. The balloons were removed. The patient remained neurologically stable with his baseline right ophthalmoplegia and V1–V2 hemianesthesia. At the 6-week follow-up, the patient remained clinically stable with no evidence of carotid-cavernous fistula or interval abscess formation. CONCLUSION: Endovascular temporary balloon occlusion of the cavernous carotid artery provides immediate control of the vessel (with an option of permanent carotid sacrifice), allowing removal of a foreign body without craniotomy in appropriate cases.

scholarly journals Giant Aneurysm of the Cervical Internal Carotid Artery Treated by Proximal Coil Embolization under Temporary Balloon Occlusion

2001 ◽  
Vol 7 (4) ◽  
pp. 331-335 ◽  
Author(s):  
A. Uchino ◽  
Y. Takase ◽  
T. Koizumi ◽  
S. Kudo
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Giant Aneurysm ◽  
Balloon Occlusion ◽  
Partial Filling ◽  
Coil Occlusion ◽  
Platinum Coils ◽  
Temporary Balloon Occlusion ◽  
Cervical Internal Carotid Artery

We report a patient with a giant aneurysm on the left cervical internal carotid artery (ICA) treated successfully by proximal coil occlusion. Fibered platinum coils were delivered via a 5-F catheter under temporary balloon occlusion of the proximal ICA and without complications. MR imaging ten months after the procedure showed the aneurysm to be reduced in size and subtotally thrombosed. Retrograde partial filling of the aneurysmal lumen was present, however. We describe the case in detail and discuss the ideal treatment of the cervical ICA aneurysm.

Cavernous Sinus Exenteration for Invasive Cranial Base Tumors

Neurosurgery ◽  
2003 ◽  
Vol 52 (4) ◽  
pp. 772-782 ◽  
Author(s):  
Bernard George ◽  
Cristina Anastasia Ferrario ◽  
Alexandre Blanquet ◽  
Frédéric Kolb
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Balloon Occlusion ◽  
Biological Behavior ◽  
Cerebrospinal Fluid Leakage ◽  
External Carotid ◽  
Occlusion Test ◽  
Balloon Occlusion Test

Abstract OBJECTIVE Invasive tumors involving the cavernous sinus, such as recurrent benign meningiomas or sarcomas, raise therapeutic problems that may be resolved by cavernous sinus exenteration (CSE). METHODS Our series comprises 18 patients (9 women and 9 men ranging in age from 14 to 64 yr) who underwent CSE during the past 8 years. The tumors in these patients included 12 meningiomas, 3 chondrosarcomas, 1 rhabdomyosarcoma, 1 lipomyosarcoma, and 1 epidermoid carcinoma. Preoperative occlusion of the internal carotid artery was confirmed in 15 cases by a balloon occlusion test. Three patients had a negative balloon occlusion test, and their internal carotid arteries were preserved (n = 1) or revascularized (n = 2) through an external carotid artery-to-middle cerebral artery bypass. RESULTS CSE was performed as a primary treatment in 5 patients and after one to five recurrences in 13 patients. In all patients, CSE included the internal carotid artery and Cranial Nerves III, IV, and VI and one to three branches of Cranial Nerve V. Orbital exenteration was performed in eight patients, and partial hypophysectomy was performed in five patients. Ten patients had received radiotherapy before CSE, and five patients underwent irradiation after CSE. The operative mortality includes two patients. Cerebrospinal fluid leakage was the main complication in four patients, with three patients having meningitis. Follow-up ranged from 6 months to 5 years, with three deaths from new recurrences at 2, 3, and 4 years after CSE. As compared with their clinical courses before CSE, all patients except the two who died postoperatively benefited from CSE. CONCLUSION CSE has useful indications in invasive and rapidly growing tumors, including apparently benign meningiomas. A better understanding of the biological behavior of these tumors is necessary for appropriate selection of patients for CSE.

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