Cavernous Internal Carotid Artery Aneurysm: Rupture of a Presumably Traumatic Cavernous Internal Carotid Artery Pseudoaneurysm with Life-Threatening Epistaxis After Endonasal Pansinus Surgery
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An 85-year-old female patient was referred to our institution by the ENT department of another hospital with nonarresting epistaxis and severe blood loss caused by a ruptured cavernous internal carotid artery (ICA) pseudoaneurysm extending into the sphenoid sinus. Preceding transnasal pansinus surgeries had presumably perforated the bone wall of the sphenoid sinus and affected the arterial wall, which had allowed a traumatic pseudoaneurysm to develop. Emergent DSA with endovascular coil occlusion of the aneurysm was performed which in turn revealed a mechanically caused high-grade stenosis with thrombotic plaques in the distal ICA. Although no ischemic infarct occurred, due to the effect of earlier epistaxis on hemodynamic stability, the patient died of cardiac failure 2 weeks later. Epistaxis in the context of cavernous ICA pseudoaneurysms is the main topic of this chapter.
KeywordsInternal carotid artery aneurysm Coiling Pansinus surgery Sphenoid sinus Epistaxis
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