Advertisement

Cavernous Internal Carotid Artery Aneurysm: Rupture of a Presumably Traumatic Cavernous Internal Carotid Artery Pseudoaneurysm with Life-Threatening Epistaxis After Endonasal Pansinus Surgery

  • Cindy RichterEmail author
  • Helmut Steinhart
  • Hans Henkes
Living reference work entry
  • 80 Downloads

Abstract

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.

Keywords

Internal carotid artery aneurysm Coiling Pansinus surgery Sphenoid sinus Epistaxis 

References

  1. Chaboki H, Patel AB, Freifeld S, Urken ML, Som PM. Cavernous carotid aneurysm presenting with epistaxis. Head Neck. 2004;26(8):741–6.  https://doi.org/10.1002/hed.20081.CrossRefPubMedGoogle Scholar
  2. Chambers EF, Rosenbaum AE, Norman D, Newton TH. Traumatic aneurysms of cavernous internal carotid artery with secondary epistaxis. AJNR Am J Neuroradiol. 1981;2(5):405–9.PubMedGoogle Scholar
  3. Cohen JE, Gomori JM, Segal R, Spivak A, Margolin E, Sviri G, Rajz G, Fraifeld S, Spektor S. Results of endovascular treatment of traumatic intracranial aneurysms. Neurosurgery. 2008;63(3):476–85 ; discussion 485–6.  https://doi.org/10.1227/01.NEU.0000324995.57376.79.CrossRefPubMedGoogle Scholar
  4. Dubey A, Sung WS, Chen YY, Amato D, Mujic A, Waites P, Erasmus A, Hunn A. Traumatic intracranial aneurysm: a brief review. J Clin Neurosci. 2008;15(6):609–12.  https://doi.org/10.1016/j.jocn.2007.11.006.CrossRefPubMedGoogle Scholar
  5. Garg K, Gurjar HK, Singh PK, Singh M, Chandra PS, Sharma BS. Internal carotid artery aneurysms presenting with epistaxis – our experience and review of literature. Turk Neurosurg. 2016;26(3):357–63.  https://doi.org/10.5137/1019-5149.JTN.12598-14.1.CrossRefPubMedGoogle Scholar
  6. Holmes B, Harbaugh RE. Traumatic intracranial aneurysms: a contemporary review. J Trauma. 1993;35(6):855–60. ReviewCrossRefGoogle Scholar
  7. Larson PS, Reisner A, Morassutti DJ, Abdulhadi B, Harpring JE. Traumatic intracranial aneurysms. Neurosurg Focus. 2000;8(1):e4. ReviewCrossRefGoogle Scholar
  8. Lempert TE, Halbach VV, Higashida RT, Dowd CF, Urwin RW, Balousek PA, Hieshima GB. Endovascular treatment of pseudoaneurysms with electrolytically detachable coils. AJNR Am J Neuroradiol. 1998;19(5):907–11.PubMedGoogle Scholar
  9. Renn WH, Rhoton AL Jr. Microsurgical anatomy of the sellar region. J Neurosurg. 1975;43(3):288–98.  https://doi.org/10.3171/jns.1975.43.3.0288.CrossRefPubMedGoogle Scholar
  10. Ronchetti G, Panciani PP, Cornali C, Mardighian D, Villaret AB, Stefini R, Fontanella MM, Gasparotti R. Ruptured aneurysm in sphenoid sinus: which is the best treatment? Case Rep Neurol. 2013;5(1):1–5.  https://doi.org/10.1159/000346347.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Neuroradiologische Klinik, Neurozentrum, Klinikum StuttgartStuttgartGermany
  2. 2.Abteilung für Neuroradiologie, Universitätsklinikum LeipzigLeipzigGermany
  3. 3.Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Marienhospital StuttgartStuttgartGermany

Personalised recommendations