scholarly journals 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

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

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

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.

Internal Carotid Artery Blowout as a Complication of Sphenoid Sinus and Skull-Base Surgery

1983 ◽  
Vol 91 (3) ◽  
pp. 308-312 ◽  
Author(s):  
Ronald S. Bogdasarian ◽  
Thomas A. Kwyer ◽  
Robert C. Dauser ◽  
William F. Chandler ◽  
Glen W. Kindt
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Sphenoid Sinus ◽  
Internal Carotid ◽  
Skull Base Surgery

scholarly journals Epistaksis masif pada pseudoaneurisma traumatik arteri karotis interna

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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