Retained Transcranial Knife Blade With Transection of the Internal Carotid Artery Treated by Staged Endovascular and Surgical Therapy: Technical Case Report

Abstract BACKGROUND AND IMPORTANCE We describe the use of proximal and distal endovascular coil embolization of the internal carotid artery followed by operative removal of a retained foreign object transecting the petrocavernous portion of the internal carotid artery. CLINICAL PRESENTATION A 20-year-old man sustained a stab wound to the left temporal skull and presented with a retained knife blade. He reported a headache at presentation, but remained neurologically intact with a Glasgow Coma Scale of 15. Computed tomography imaging and subsequent angiography confirmed complete transection of the petrocavernous segment of the left internal carotid artery with effective tamponade by the knife blade in situ and satisfactory collateral flow across the Circle of Willis. Coil embolization of the left internal carotid artery was performed. Retrograde embolization of the petrocavernous internal carotid segment distal to the injury was performed via vertebral and posterior communicating artery access. Antegrade embolization of the internal carotid artery proximal to the injury was completed and the patient was transferred to the operating room for craniectomy and foreign body extraction. Postoperative computed tomography angiography revealed no parenchymal hemorrhage, mass effect, or midline shift, and successful embolization of the internal carotid artery. At 6-week follow-up, the patient remained neurologically intact with no infectious or vascular complications. CONCLUSION Staged endovascular and surgical therapy provides complete assessment and effective control of damaged vessels when retained intracranial foreign bodies are present. Given the high risk of vascular injury with retained transcranial foreign bodies, this strategy should be considered a safe approach for these challenging cases.

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Fenestration of a Supraclinoid Internal Carotid Artery Associated With Dual Aneurysms: Case Report

Neurosurgery ◽

10.1227/neu.0b013e318223b613 ◽

2011 ◽

Vol 69 (4) ◽

pp. E1005-E1009 ◽

Cited By ~ 14

Author(s):

Tsuyoshi Ichikawa ◽

Shigeru Miyachi ◽

Takashi Izumi ◽

Noriaki Matsubara ◽

Takehiro Naito ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Coil Embolization ◽

Internal Carotid ◽

Neurological Deficits ◽

Left Internal Carotid Artery ◽

High Incidence ◽

Endovascular Coil Embolization ◽

Proximal Occlusion ◽

Supraclinoid Internal Carotid Artery

Abstract BACKGROUND AND IMPORTANCE: We present a rare case of fenestration of the left supraclinoid intracranial internal carotid artery with 2 associated aneurysms arising proximally and distally from the fenestration that were successfully treated with endovascular coil embolization. This is the first report of these types of aneurysms treated with coiling alone. CLINICAL PRESENTATION: A 47-year-old woman underwent a diagnostic workup; magnetic resonance angiography incidentally revealed 2 tandem aneurysms at the supraclinoid and paraclinoid portion of the left internal carotid artery. Angiography revealed fenestration of the left supraclinoid internal carotid artery with 2 aneurysms both proximal and distal to the fenestration. The patient underwent endovascular coil embolization of the aneurysms simultaneously. The smaller trunk was intentionally occluded to achieve complete packing of the proximal aneurysm. Both aneurysms were totally occluded, and no neurological deficits developed in the patient. CONCLUSION: Based on previous reports, fenestration has the potential to form an aneurysm, and there seemed to be a relatively high incidence of rupture if accompanied by aneurysm. Coiling is one good option to treat aneurysms and should be considered when multiple aneurysms exist because all aneurysms can be treated simultaneously. Proximal occlusion of the smaller trunk is acceptable because of a retrograde flow from the distal end, even if one exists.

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Left internal carotid artery agenesis in a patient with headache

Headache Medicine ◽

10.48208/headachemed.2014.5 ◽

2014 ◽

pp. 25-27

Author(s):

Inês Alice Teixeira Leão ◽

C. H. Rezende ◽

J. B. L. Gomes ◽

R. F. Almeida

Keyword(s):

Computed Tomography ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Rare Case ◽

Internal Carotid ◽

Left Internal Carotid Artery ◽

Left Middle Cerebral Artery ◽

Clinical Neurology ◽

Structural Lesion ◽

Left Middle

Sometimes in clinical neurology, we diagnose a very rare case. We report on a patient who presented with crisis of headache and vomiting (clinically diagnose as migraine). Computed tomography (CT) scan of the head did not reveal any structural lesion. Magnetic resonance angiography showed absence of left internal carotid artery associated with absence of the left middle cerebral artery (MCA).

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Endovascular coil embolization of the left internal carotid artery aneurysm. Case report.

Polish Journal of Surgery ◽

10.5604/01.3001.0014.3019 ◽

2020 ◽

Vol 92 (5) ◽

pp. 1-5

Author(s):

Adam Lipowski ◽

Sleiman Aboul-Hassan ◽

Zbigniew Krasiński ◽

Konrad Woronowicz

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Coil Embolization ◽

Internal Carotid ◽

Artery Aneurysm ◽

Left Internal Carotid Artery ◽

Carotid Artery Aneurysm ◽

Internal Carotid Artery Aneurysm ◽

Endovascular Coil Embolization ◽

Angio Ct

In the current case report we present a novel case of a successful coil embolization of the left internal carotid artery aneurysm. Patient presented with neck pain and a palpable pulsating tumor was admitted to the vascular surgery clinic where neck Angio-CT scan was performed. Angio-CT revealed left internal carotid artery aneurysm with a narrow neck. Patient was admitted to the department of vascular surgery where the patient was enrolled into endovascular coil embolization. After the procedure, control angiography showed complete embolization of the aneurysm. Three months following the procedure, doppler ultrasonography of the carotid arteries showed no demonstrable flow into the aneurysm. Six months following the procedure, angio-CT confirmed complete aneurysm thrombosis. Based on this case, endovascular coil embolization of the carotid artery aneurysms is safe and effective method of treatment. Keywords: tumor, aneurysm, coile.

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Pseudoaneurysm of the left internal carotid artery following tonsillectomy

VASA ◽

10.1024/0301-1526/a000153 ◽

2011 ◽

Vol 40 (6) ◽

pp. 491-494 ◽

Cited By ~ 4

Author(s):

Vávrová ◽

Slezácek ◽

Vávra ◽

Karlová ◽

Procházka

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Rare Complication ◽

Left Internal Carotid Artery ◽

Acute Tonsillitis ◽

Artery Pseudoaneurysm ◽

Complete Occlusion ◽

Endovascular Approach ◽

Deep Neck Infections

Internal carotid artery pseudoaneurysm is a rare complication of deep neck infections. The authors report the case of a 17-year-old male who presented to the Department of Otorhinolaryngology with an acute tonsillitis requiring tonsillectomy. Four weeks after the surgery the patient was readmitted because of progressive swallowing, trismus, and worsening headache. Computed tomography revealed a pseudoaneurysm of the left internal carotid artery in the extracranial segment. A bare Wallstent was implanted primarily and a complete occlusion of the pseudoaneurysm was achieved. The endovascular approach is a quick and safe method for the treatment of a pseudoaneurysm of the internal carotid artery.

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Transcavernous Resection of a Giant Extensive Chondrosarcoma with Endoscopic Assistance

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0041-1727124 ◽

2021 ◽

Author(s):

Walid Elshamy ◽

Burcak Soylemez ◽

Sima Sayyahmelli ◽

Nese Keser ◽

Mustafa K. Baskaya

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Skull Base ◽

Internal Carotid ◽

Gross Total Resection ◽

Petrous Apex ◽

Left Internal Carotid Artery ◽

Total Resection ◽

Complete Occlusion ◽

Grade Ii

AbstractChondrosarcomas are one of the major malignant neoplasms which occur at the skull base. These tumors are locally invasive. Gross total resection of chondrosarcomas is associated with longer progression-free survival rates. The patient is a 55-year-old man with a history of dysphagia, left eye dryness, hearing loss, and left-sided facial pain. Magnetic resonance imaging (MRI) showed a giant heterogeneously enhancing left-sided skull base mass within the cavernous sinus and the petrous apex with extension into the sphenoid bone, clivus, and the cerebellopontine angle, with associated displacement of the brainstem (Fig. 1). An endoscopic endonasal biopsy revealed a grade-II chondrosarcoma. The patient was then referred for surgical resection. Computed tomography (CT) scan and CT angiogram of the head and neck showed a left-sided skull base mass, partial destruction of the petrous apex, and complete or near-complete occlusion of the left internal carotid artery. Digital subtraction angiography confirmed complete occlusion of the left internal carotid artery with cortical, vertebrobasilar, and leptomeningeal collateral development. The decision was made to proceed with a left-sided transcavernous approach with possible petrous apex drilling. During surgery, minimal petrous apex drilling was necessary due to autopetrosectomy by the tumor. Endoscopy was used to assist achieving gross total resection (Fig. 2). Surgery and postoperative course were uneventful. MRI confirmed gross total resection of the tumor. The histopathology was a grade-II chondrosarcoma. The patient received proton therapy and continues to do well without recurrence at 4-year follow-up. This video demonstrates steps of the combined microsurgical skull base approaches for resection of these challenging tumors.The link to the video can be found at: https://youtu.be/WlmCP_-i57s.

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Successful Bridging Therapy in a 103-Year-Old Woman with Acute Terminal Internal Carotid Artery Occlusion

Case Reports in Neurology ◽

10.1159/000507693 ◽

2020 ◽

Vol 12 (Suppl. 1) ◽

pp. 9-14

Author(s):

Trung Quoc Nguyen ◽

Hoang Thi Phan ◽

Tinh Quang Dang ◽

Vu Thanh Tran ◽

Thang Huy Nguyen

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Intravenous Thrombolysis ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Left Internal Carotid Artery ◽

Bridging Therapy ◽

Nihss Score ◽

Current Guidelines

The efficacy of intravenous thrombolysis and endovascular therapy and their favorable treatment outcomes have been established in clinical trials irrespective of age. Current guidelines do not recommend an age limit in selecting eligible patients for reperfusion treatment as long as other criteria are satisfied. A 103-year-old woman was admitted at our hospital within 1 h of stroke onset secondary to a left internal carotid artery terminus occlusion. On admission, her National Institutes of Health Stroke Scale (NIHSS) score was 30, with a small left thalamic diffusion restriction lesion on MRI. Her medical history included paroxysmal atrial fibrillation, prior myocardial infarction, hypertension, chronic kidney disease, and diabetes mellitus. Her pre-stroke modified Rankin Scale score was 0, and she was fully independent before stroke. Once intravenous thrombolysis was started, the patient successfully underwent mechanical thrombectomy, and thrombolysis in cerebral infarction-3 recanalization was achieved 225 min after symptom onset. She showed dramatic recovery (NIHSS score of 5 after 48 h) and was discharged on day 7 with a modified Rankin Score of 1. To our knowledge, our patient is the second oldest documented patient who successfully underwent bridging therapy for stroke.

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Developmental Anatomy of the Eustachian Tube: Implications for Balloon Dilation

Otolaryngology ◽

10.1177/0194599821994817 ◽

2021 ◽

pp. 019459982199481

Author(s):

Isabelle Magro ◽

David Pastel ◽

Jace Hilton ◽

Mia Miller ◽

James Saunders ◽

...

Keyword(s):

Computed Tomography ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Eustachian Tube ◽

Internal Carotid ◽

Tertiary Care ◽

Balloon Dilation ◽

Care Hospital ◽

Developmental Anatomy ◽

Nasal Floor

Objective To describe the developmental anatomy of the eustachian tube (ET) and its relationship to surrounding structures on computed tomography. Study Design Case series with chart review. Setting A tertiary care hospital. Methods ET anatomy was assessed with reformatted high-resolution computed tomography scans from 2010 to 2018. Scans (n = 78) were randomly selected from the following age groups: <4, 5 to 7, 8 to 18, and >18 years. The following were measured and compared between groups: ET length, angles, and relationship between its bony cartilaginous junction and the internal carotid artery and between its nasopharyngeal opening and the nasal floor. Results The distance between the bony cartilaginous junction and internal carotid artery decreased with age between the <4-year-olds (2.4 ± 0.6 mm) and the 5- to 7-year-olds (2.0 ± 0.3 mm, P = .001). The ET length increased among the <4-year-olds (32 mm), 5- to 7-year-olds (36 mm), and 8- to 18-year-olds (41 mm, P < .0001). The cartilaginous ET increased among the <4-year-olds (20 mm), 5- to 7-year-olds (25 mm), and 8- to 18-year-olds (28 mm, P < .0001). The ET horizontal angle increased among the <4-year-olds (17°), 5- to 7-year-olds (21°), and 8- to 18-year-olds (23°, P≤ .003), but the ET sagittal angle did not statistically change after 5 years of age. The height difference between the nasopharyngeal opening of the ET and the nasal floor increased among the <4-year-olds (4 mm), 5- to 7-year-olds (7 mm), and 8- to 18-year-olds (11 mm, P < .0001). Conclusion The ET elongates with age, and its angles and relationship to the nasal floor increase. Although some parameters mature faster, more than half of the ET growth occurs by 8 years of age, and adult morphology is achieved by early adolescence.

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Management of Mobile Thrombus With Distal Protection Devices During Carotid Artery Angioplasty: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opab131 ◽

2021 ◽

Author(s):

Salomon Cohen-Cohen ◽

Giuseppe Lanzino ◽

Waleed Brinjikji ◽

Adam Arthur ◽

Mark Bain ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Mechanical Thrombectomy ◽

Standard Of Care ◽

Video Production ◽

Left Internal Carotid Artery ◽

Left Middle Cerebral Artery ◽

Cerebral Angiogram ◽

Protection Devices

Abstract Embolic protection devices (EPDs) have become a standard of care during internal carotid artery revascularization.1,2 This video is about a 57-yr-old-male who presented with a wake-up stroke with a left hemispheric syndrome. Head computed tomography angiography (CTA) revealed tandem occlusions of the proximal left internal carotid artery (ICA) and of the distal left middle cerebral artery (MCA) with an ASPECT (Alberta Stroke Program Early CT Score) score of 6. The patient underwent a cerebral angiogram and was treated with balloon angioplasty with a distal EPD and mechanical thrombectomy. The EPD became occluded with thrombus from the ICA and was retrieved through a 6-Fr Sofia (MicroVention) under continuous aspiration. Successful revascularization of the proximal ICA and distal MCA was achieved. No procedure-related complications occurred, and the patient's neurological exam improved. Tandem occlusions can occur in up to 15% of strokes. The optimal treatment can be controversial, but mechanical thrombectomy and ICA revascularization with a distal EPD appear to be safe and effective in selected patients.3 Consent was obtained for the procedure and for the video production.

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Trigeminal Neuralgia Associated with a Primitive Trigeminal Artery Variant: Case Report

Neurosurgery ◽

10.1093/neurosurgery/52.5.1217 ◽

2003 ◽

Vol 52 (5) ◽

pp. 1217-1220

Author(s):

Yoji Tamura ◽

Hiroshi Shimano ◽

Toshihiko Kuroiwa ◽

Yoshihito Miki

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Trigeminal Neuralgia ◽

Internal Carotid ◽

Left Internal Carotid Artery ◽

Decompression Surgery ◽

Trigeminal Artery ◽

Cerebellar Artery ◽

Primitive Trigeminal Artery ◽

Perforating Arteries

Abstract OBJECTIVE AND IMPORTANCE A variant type of the primitive trigeminal artery (PTA) is a rare anomalous vessel that originates from the internal carotid artery and directly supplies the territory of the anteroinferior cerebellar artery and/or the superior cerebellar artery. We report a case of trigeminal neuralgia associated with this PTA variant, and we discuss the characteristics of this vessel. CLINICAL PRESENTATION A 51-year-old woman presented with a 10-year history of left paroxysmal facial pain. Magnetic resonance angiography and cerebral angiography demonstrated that an aberrant vessel originating from the left internal carotid artery directly supplied the cerebellum, without a basilar artery anastomosis. INTERVENTION Surgical exploration was performed via a left retrosigmoid approach. A loop of the aberrant vessel, which entered the posterior fossa through the isolated dural foramen, was compressing the trigeminal nerve. This aberrant vessel was displaced medially from the nerve with a prosthesis, with care to avoid kinking and avulsion of the perforating arteries. The patient's neuralgia resolved postoperatively. CONCLUSION Although the PTA variant is frequently associated with intracranial aneurysms, it is extremely rare for the variant to lead to trigeminal neuralgia. During microvascular decompression surgery, surgeons should be careful to prevent injury of the perforating arteries arising from the PTA variant.

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