Rupture of Internal carotid artery pseudoaneurysm in the sphenoid sinus as a complication of deep neck space infection

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.

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Pseudoaneurysm of the Internal Carotid Artery Complicating Deep Neck Space Infection

The Journal of Pediatrics ◽

10.1016/j.jpeds.2010.03.003 ◽

2010 ◽

Vol 157 (3) ◽

pp. 510 ◽

Cited By ~ 3

Author(s):

Marc Makeieff ◽

Pierfrancesco Pelliccia ◽

Michel Mondain ◽

Paolo Machi

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Space Infection ◽

Deep Neck Space Infection

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

The Journal of Laryngology & Otology ◽

10.1017/s0022215108002752 ◽

2008 ◽

Vol 123 (6) ◽

pp. 692-694 ◽

Cited By ~ 12

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.

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Endovascular Management of Internal Carotid Artery Pseudoaneurysm Secondary to Pediatric Deep Neck Space Infection: A Case Report and Review of Literature

The Arab Journal of Interventional Radiology ◽

10.1055/s-0041-1740341 ◽

2022 ◽

Author(s):

Rengarajan Rajagopal ◽

Smily Sharma ◽

Meenu Bagarhatta ◽

Sarbesh Tiwari ◽

Rajeev Bagarhatta

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Artery Occlusion ◽

Parent Artery ◽

Complication Rates ◽

Endovascular Management ◽

Artery Pseudoaneurysm ◽

Space Infection ◽

Parent Artery Occlusion

AbstractPseudoaneurysms of extracranial internal carotid artery (ICA) are rare in children. Main causes include trauma, iatrogenic causes, and neck space infection. Prompt diagnosis and management is vital, in view of life-threatening complications like fatal airway hemorrhage and stroke. Endovascular management has currently become the preferred treatment strategy due to its minimally invasive nature and lower complication rates. We report a rare case of mycotic pseudoaneurysm of extracranial ICA in a 4-year-old child as a complication of neck space infection, which was successfully managed with endovascular parent artery occlusion.

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

Clinical Radiology ◽

10.1016/j.crad.2011.12.009 ◽

2012 ◽

Vol 67 (8) ◽

pp. 815-820 ◽

Cited By ~ 3

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

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Epistaksis masif pada pseudoaneurisma traumatik arteri karotis interna

Oto Rhino Laryngologica Indonesiana ◽

10.32637/orli.v46i2.166 ◽

2016 ◽

Vol 46 (2) ◽

pp. 184

Author(s):

Anna Mailasari Kusuma Dewi

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Ct Scan ◽

Effective Treatment ◽

Sphenoid Sinus ◽

Internal Carotid ◽

Case Reports ◽

Blood Clot ◽

Artery Pseudoaneurysm ◽

Traumatic Pseudoaneurysm

Latar belakang: Pseudoaneurisma arteri karotis interna merupakan kasus yang jarang dijumpai, dengan gejala berupa perdarahan masif yang dapat terjadi secara lambat dan berulang. Pemeriksaan arteriografi merupakan prosedur standar untuk mengetahui sumber perdarahan. Tindakan embolisasi efektif untuk menghentikan perdarahan. Tujuan: Melaporkan kasus epistaksis masif pada pseudoaneurisma traumatik arteri karotis interna. Kasus: Pasien laki-laki berumur 19 tahun dengan trauma sinus sfenoid pasca kecelakaan, mengalami epistaksis masif berulang selama 7 bulan. Hasil nasoendoskopi didapati bekuan darah pada meatus superior, hasil CT scan menunjukkan lesi isodens pada sinus frontalis dan etmoid kanan, serta sinus sfenoid dan maksila bilateral, disertai gambaran arteri karotis komunis interna segmen kavernosus masuk ke sinus sfenoid melalui celah fraktur di sfenoid. Penatalaksaan berupa embolisasi dengan balloon. Pasca embolisasi tidak didapatkan perdarahan aktif. Metode: Penelusuran kepustakaan menghasilkan 33 jurnal, dan terdapat 10 jurnal yang relevan. Hasil: Dari 10 jurnal yang didapatkan, ditemukan 6 laporan kasus dan 4 hasil penelitian pseudoaneurisma traumatik arteri karotis interna yang ditatalaksana dengan embolisasi, mendapat keberhasilan yang tinggi, dan angka komplikasi yang rendah. Kesimpulan: Pseudoaneurisma traumatik karotis interna menimbulkan epistaksis masif berulang, yang membutuhkan ketepatan pemeriksaan penunjang untuk menegakkan diagnosis. Penatalaksanaan dengan embolisasi merupakan pilihan yang efektif untuk mencegah mortalitas.Kata kunci: Pseudoaneurisma karotis interna, trauma sinus sfenoid, epistaksis masifABSTRACT Background: Post injury internal carotid artery pseudoaneurysm is a rare case, mostly caused by head trauma. The symptoms are delayed and recurrent massive epistaxis. Angiography is the gold standard for confirming the diagnosis and visualizing the bleeding point. Endovascular interventions with depleted balloons and coils are effective treatment. Purpose: To report a case of massive epistaxis related to traumatic pseudoaneurysm of internal carotid artery. Case: A nineteen-years old male with sphenoid sinus injury caused by vehicle accident, which subsequently developed recurrent episodes of massive epistaxis for seventh month afterwards. He had undergone blood transfusion and nasal packing to control the bleeding. Nasal endoscopic examination showed blood clot in the superior meatus, while paranasal sinuses CT Scan showed isodense lesion in the right frontal and ethmoid sinuses, and bilateral sphenoid and maxillary sinuses. Cavernous segment of carotid communis artery entered into sphenoid sinus through a fracture line in the superior part of the sinus. Post arteriography and balloon embolization, there was no active anterior and posterior bleeding. Method: Searching for evidence produced 31 journals, and 10 journals were relevant to our clinical question. Result: From the 10 journals, 6 were case reports and 4 were researches of traumatic pseudoaneurysm of internal carotid artery which were treated by embolization. The results were good and complications were minimal. Conclusion: Traumatic pseudoaneurysm of internal carotid artery could cause massive epistaxis that requires a right clinical setting to diagnose, and embolization is the effective treatment to prevent mortality.Keywords: Internal carotid artery pseudoaneurysm, sphenoid sinuses trauma, massive epistaxis

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Rupture of an Internal Carotid Artery Pseudoaneurysm and Bleeding of the Sphenopalatine Artery in a Patient with Skull Base Osteoradionecrosis after Radiotherapy for Sphenoid Sinus Carcinoma

Nihon Bika Gakkai Kaishi (Japanese Journal of Rhinology) ◽

10.7248/jjrhi.59.49 ◽

2020 ◽

Vol 59 (1) ◽

pp. 49-55

Author(s):

Hiroyuki Mihashi ◽

Ryouta Mihashi ◽

Kei Nagata ◽

Hirohito Umeno

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Skull Base ◽

Sphenoid Sinus ◽

Internal Carotid ◽

Artery Pseudoaneurysm ◽

Sphenopalatine Artery

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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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