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Cusick B, Casler JD, David C. Traumatic Aneurysm of the Cavernous Carotid Artery: Management of Delayed Massive Epistaxis. ACTA ACUST UNITED AC 2018. [DOI: 10.2500/105065892781874559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Traumatic aneurysm of the internal carotid artery (ICA) occasionally may present with delayed cataclysmic epistaxis. Lack of awareness of this phenomenon has led to misdiagnosis and delay of treatment in many instances. Consequently, this clinical scenario is associated with a high rate of mortality. Analysis of this entity allows division of management into an immediate phase where bleeding is stopped, the patient is stabilized, and a later phase where definitive treatment is rendered. To gain a fuller understanding of this potentially life-threatening problem, the following case is presented.
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Affiliation(s)
- Brian Cusick
- University of California, Davis, Medical Center, Department of Otolaryngology, 2360 Stockton Boulevard, Sacramento, CA 95817
| | - John D. Casler
- Otolaryngology Service, Letterman Army Medical Center, San Francisco, California USA
| | - Christopher David
- University of California, School of Medicine, Department of Radiology, San Francisco, California
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2
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Giant bilateral cavernous-carotid aneurysms complicated by epistaxis. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 133:129-31. [PMID: 26778444 DOI: 10.1016/j.anorl.2015.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Epistaxis secondary to a ruptured cavernous-carotid aneurysm that has eroded into the sphenoid sinus is a life-threatening condition. When it is unilateral, balloon or coil embolization of the parent vessel should be considered. When bilateral, coiling the aneurysm to gain hemostasis followed by stent insertion after anticoagulation has been shown to be successful in achieving stabilization of the aneurysm wall whilst maintaining flow through the artery. CASE REPORT We present a case of epistaxis secondary to giant bilateral cavernous-carotid aneurysm. Despite successfully excluding the left-sided aneurysm from the circulation, using coils, recurrent right-sided epistaxis proved extremely difficult to control and ultimately led to the death of our patient. DISCUSSION In recurrent life-threatening episodes of epistaxis resistant to endovascular hemorrhage control, the sphenoid sinus should be packed with bone wax, in order to prevent further episodes of potentially fatal epistaxis, awaiting definitive neuro-radiological intervention.
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3
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Sharma K, Phadke RV, Pandey A, Verma A. Visual Loss with Epistaxis. Neuroophthalmology 2005. [DOI: 10.1080/01658100590933451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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4
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Karkanevatos A, Karkos PD, Karagama YG, Foy P. Massive recurrent epistaxis from non-traumatic bilateral intracavernous carotid artery aneurysms. Eur Arch Otorhinolaryngol 2004; 262:546-9. [PMID: 15592857 DOI: 10.1007/s00405-004-0869-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2004] [Accepted: 09/02/2004] [Indexed: 11/30/2022]
Abstract
Recurrent epistaxis may rarely follow traumatic intracavernous carotid artery aneurysm. This occurs nearly always after head injury and is usually associated with fracture of the skull base. Severe torrential epistaxis due to non-traumatic intracavernous carotid artery aneurysm is extremely uncommon and potentially fatal, with only a few cases having been reported in the literature. We present the case of a 23-year-old female with a history of recurrent severe epistaxis and otalgia due to bilateral intracavernous carotid artery aneurysms, illustrating the diagnostic difficulties. The radiological investigations and the management of the patient are discussed and relevant literature is reviewed.
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Affiliation(s)
- A Karkanevatos
- Department of Otolaryngology Head and Neck Surgery, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL, UK
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5
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Bhatoe HS, Phadke RV. Traumatic internal carotid artery aneurysm. INDIAN JOURNAL OF NEUROTRAUMA 2004. [DOI: 10.1016/s0973-0508(04)80028-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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6
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Komiyama M, Morikawa T, Nakajima H, Yasui T, Kan M. "Early" apoplexy due to traumatic intracranial aneurysm--case report. Neurol Med Chir (Tokyo) 2001; 41:264-70. [PMID: 11396307 DOI: 10.2176/nmc.41.264] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 76-year-old man presented with a traumatic aneurysm of the left internal carotid artery which caused repeated subarachnoid hemorrhages within 20 hours of a fall from a height. Early computed tomography (CT) detected no brain abnormalities, but repeat CT found subarachnoid hemorrhage. Internal carotid angiography detected a pseudoaneurysm, which was not treated because of his poor clinical condition. He died of multiple organ failure. Early detection of a traumatic intracranial aneurysm is important for the prevention of aneurysmal rupture, or "delayed" apoplexy. Review of 171 cases with traumatic aneurysms from the literature found that false negative angiography occurred only in three cases on post-trauma day 7 and thereafter. Early diagnostic angiography within a week of the initial trauma is indicated if traumatic aneurysm is suspected to detect early signs of irregularity, spasm, and narrowing of the arterial wall. Repeat angiography is indicated if aneurysmal formation is still highly suspected in spite of negative initial angiography.
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Affiliation(s)
- M Komiyama
- Department of Neurosurgery, Osaka City General Hospital, Osaka
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7
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Kim JY, Farkas J, Putman CM, Varvares M. Paraclinoid internal carotid artery aneurysm presenting as massive epistaxis. Ann Otol Rhinol Laryngol 2000; 109:782-6. [PMID: 10961814 DOI: 10.1177/000348940010900815] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- J Y Kim
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston 02114, USA
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8
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Sudhoff H, Stark T, Knorz S, Luckhaupt H, Borkowski G. Massive epistaxis after rupture of intracavernous carotid artery aneurysm. Case report. Ann Otol Rhinol Laryngol 2000; 109:776-8. [PMID: 10961812 DOI: 10.1177/000348940010900813] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present a case of massive epistaxis caused by an internal carotid artery aneurysm. The initial treatment with endovascular balloon embolization failed as a result of balloon displacement. After rebleeding, the intracavernous aneurysm was treated with an endovascular detachable balloon embolization technique, which resulted in cessation of epistaxis. The different treatment options for interventional radiology and management of ruptured carotid artery aneurysms are discussed.
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Affiliation(s)
- H Sudhoff
- Department of Otorhinolaryngology-Head and Neck Surgery, St Elisabeth Hospital, University of Bochum, Germany
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9
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Abstract
A series of 115 intracavernous internal carotid artery (ICA) aneurysms have been treated by a direct surgical approach during the past 15 years. Sixty-eight aneurysms were small. Of these 11 were traumatic; nine caused by severe head injury and 2 by ICA injury during transsphenoidal surgery. Twenty-six aneurysms were large and 21 were giant. Thirty-eight aneurysms were clipped, 46 were treated by resection followed by ICA wall reconstruction with interrupted sutures, 16 by excision and proximal/distal ICA end-to-end anastomosis and 15 by resection/grafting. Postoperative angiography was performed in 107 cases and the ICA was found to be patent in 100 of these. Three patients died after surgery, two (with traumatic aneurysms) from associated brain injury and 1 from pulmonary embolism. Oculomotor palsy was present in the immediate postoperative period in 104 patients. However, six months after surgery only 7 patients had residual palsy. The direct surgical approach to intracavernous ICA aneurysms has constantly been changed and improved. The approach in its original version [6] was mainly intradural, whereas its contemporary version in most cases is extradural [10, 11]. The latter approach provides complete exposure of the entire parasellar region, good proximal control of the ICA [13], and good access to the cavernous sinus through the individual "corridors" between the cranial nerves [7]. In the author's opinion the direct surgical approach provides better results than endovascular treatment with regard to patency of the ICA [11].
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Affiliation(s)
- V V Dolenc
- University Medical Centre, Department of Neurosurgery, Ljubljana, Slovenia
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10
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Chen D, Concus AP, Halbach VV, Cheung SW. Epistaxis originating from traumatic pseudoaneurysm of the internal carotid artery: diagnosis and endovascular therapy. Laryngoscope 1998; 108:326-31. [PMID: 9504602 DOI: 10.1097/00005537-199803000-00004] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Posttraumatic pseudoaneurysm of the internal carotid artery (ICA) is an uncommon but potentially fatal cause of epistaxis. Because the onset of delayed bleeding from the time of injury is variable, prompt diagnosis of cavernous ICA pseudoaneurysm is often a clinical challenge. The relative urgency to evaluate for this disease is highlighted by the morbid nature of this entity. Optimal management demands rapid recognition and treatment to give the best functional outcome. The authors present a case series of six patients with skull base ICA pseudoaneurysm. A unifying feature in the majority of patients is the development of delayed, massive epistaxis. The time course for presentation of delayed life-threatening epistaxis ranged from 5 days to 9 weeks. Two patients exhibited the classic triad of unilateral blindness, orbital fractures, and massive epistaxis. All patients requiring intervention were successfully treated with endovascular embolization techniques that included detachable balloons and coils. The clinical and radiologic findings in this case series are presented. The relevant anatomy, diagnosis, and treatment of traumatic ICA pseudoaneurysm are reviewed. A contemporary treatment strategy is proposed.
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Affiliation(s)
- D Chen
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, USA
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11
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Ortiz O, Voelker J, Eneorji F. Transient enlargement of an intracranial aneurysm during pregnancy: case report. SURGICAL NEUROLOGY 1997; 47:527-31. [PMID: 9167776 DOI: 10.1016/s0090-3019(96)00151-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The association of intracranial aneurysm and pregnancy is uncommon. Hemodynamic stress plays an important role in the growth of aneurysms. METHODS The authors report the case of an enlarging cavernous carotid aneurysm in a pregnant 15-year-old young woman. RESULTS The aneurysm was initially diagnosed prior to the patient's pregnancy by both cross-sectional imaging and cerebral angiography. Further imaging evaluation was required during pregnancy, which demonstrated significant enlargement of the aneurysm. Following delivery, the lesion decreased in size. CONCLUSIONS We review potential factors associated with pregnancy that may increase hemodynamic stress and influence aneurysm growth. Additionally, the management of pregnancy-related intracranial aneurysms is discussed.
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Affiliation(s)
- O Ortiz
- Department of Radiology, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown 26506-9235, USA
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12
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Bavinzski G, Killer M, Knosp E, Ferraz-Leite H, Gruber A, Richling B. False aneurysms of the intracavernous carotid artery--report of 7 cases. Acta Neurochir (Wien) 1997; 139:37-43. [PMID: 9059710 DOI: 10.1007/bf01850866] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We present 7 cases of false intracavernous carotid artery aneurysms. Four occurred after trauma and three were caused iatrogenically. Two of the latter occurred in patients with pituitary adenomas, one after transsphenoidal microsurgery and the other after yttrium [YI90] seed implantation into the sella. The third iatrogenic aneurysm was seen shortly after transcavernous tumour surgery. In five of our seven patients massive, delayed, life-threatening epistaxis was the leading symptom. All traumatic cases were associated with immediate unilateral blindness or blurred vision and with skull base fractures. One of these had a concomitant carotid cavernous fistula. Treatment of choice of our 5 recent cases was permanent balloon occlusion of the intracavernous carotid artery at the level of the lesion. Collateral circulation was evaluated prior to definitive carotid occlusion using a balloon test occlusion. During the balloon test adequate collateral circulation was defined as symmetric angiographic filling of both hemispheres. Awake patients were neurologically examined continuously. In unconscious patients transcranial Doppler sonography, electroencephalographic and somatosensory evoked potential monitoring was used in addition. Intra-operative heparin administration was not reversed with protamin. A postoperative continuous heparin infusion was not found necessary. In our two early cases this technique was not available: In the first case we accomplished aneurysm occlusion by a surgically introduced Fogarty balloon catheter. Our second patient needed surgical trapping of the involved carotid after early unsuccessful attempts of selective aneurysm occlusion. After treatment no further epistaxis occurred. Follow-up angiography showed persistent aneurysm occlusion. The results were excellent in 5 cases and good in 1 case. One patient with bilateral lesions suffered a stroke after occlusion of the second, remaining carotid artery, despite functioning bilateral extra-intracranial bypasses. Four years later there is a mild dysphasia still present in this patient. The mean follow-up time was 75.6 months.
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Affiliation(s)
- G Bavinzski
- Department of Neurosurgery, University of Vienna, Austria
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13
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14
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Yang X, Saari T, Kansanen M, Puranen M, Soimakallio S. Epistaxis from nontraumatic intracavernous carotid aneurysm: endovascular treatment with detachable coils and electrothrombosis. Am J Otolaryngol 1995; 16:255-9. [PMID: 7573747 DOI: 10.1016/0196-0709(95)90153-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- X Yang
- Department of Clinical Radiology, Kuopio University Hospital, Finland
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15
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Bhatoe HS, Suryanarayana KV, Gill HS. Recurrent massive epistaxis due to traumatic intracavernous internal carotid artery aneurysm. J Laryngol Otol 1995; 109:650-2. [PMID: 7561475 DOI: 10.1017/s0022215100130932] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Traumatic internal carotid artery aneurysm presenting with epistaxis is rare. Epistaxis often occurs after a delay of weeks to months following head injury. The present case had bouts of recurrent massive epistaxis nearly four months after head injury. Diagnosis was made after carotid angiography. Epistaxis ceased after ipsilateral carotid ligation.
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Affiliation(s)
- H S Bhatoe
- Department of Neurosurgery, Command Hospital (SC), Pune, Maharashtra, India
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16
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Delayed Intracerebral Hematoma Caused by Traumatic Intracavernous Aneurysm. Neurosurgery 1995. [DOI: 10.1097/00006123-199502000-00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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17
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Abstract
Although delayed intracerebral hematomas from head injury are not uncommon, they are extremely rare when they are caused by extradural (extracranial) pseudoaneurysms of the internal carotid artery in the cavernous sinus. The case of a 33-year-old man who sustained a delayed frontal intracerebral hematoma from a traumatic intracavernous aneurysm 32 days after a head injury is presented. Posterior frontal base fractures accounted for monocular blindness and injury over the anterior siphon of the intracavernous carotid artery, which resulted in the formation of a pseudoaneurysm inside the sphenoid sinus. Subsequently, the cranial base fractures with secondary defects provided a route for the pseudoaneurysm to rupture intracranially and also accounted for intractable cerebrospinal fluid rhinorrhea and pneumocephalus after surgical treatment for the pseudoaneurysm and the intracerebral hematoma.
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Affiliation(s)
- T K Lin
- Department of Surgery, Chang Gung Medical College, Taipei, Taiwan
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18
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Ventureyra EC, Higgins MJ. Traumatic intracranial aneurysms in childhood and adolescence. Case reports and review of the literature. Childs Nerv Syst 1994; 10:361-79. [PMID: 7842423 DOI: 10.1007/bf00335125] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We report four pediatric traumatic intracranial aneurysms occurring before the age of 10 years. Two of these aneurysms were the result of closed head injury. The remaining two were iatrogenic aneurysms which occurred in unusual circumstances. These four children represent 33% of the pediatric intracranial aneurysms seen at the Children's Hospital of Eastern Ontario from 1974 to 1992. Diagnosis of traumatic intracranial aneurysms requires a high index of suspicion: any head-injured or postoperative child who experiences delayed neurologic deterioration, or who fails to improve as expected following treatment, should promptly undergo diagnostic intracranial imaging. Documented subarachnoid hemorrhage, intracerebral or intraventricular hemorrhage, or subdural haematoma in this clinical setting should be further investigated by cerebral angiography to exclude a traumatic aneurysm or other vascular lesion. Traumatic aneurysms typically arise at the skull base or from distal anterior or middle cerebral arteries or branches consequent to direct mural injury or to acceleration-induced shear. Reported traumatic aneurysms account for 14%-39% of all pediatric aneurysms. Iatrogenic aneurysms also occur with unexpected frequency during childhood and adolescence. Pediatric traumatic cerebral aneurysms may present early or late. Most present early with intracranial hemorrhage. Late presentation occurs infrequently, typically as an aneurysmal mass. Once diagnosed, these aneurysms should be promptly treated by craniotomy employing routine microsurgical techniques, or in some cases, by endovascular detachable balloon techniques. Delay in operative treatment entails significant risks of repeated hemorrhage and death. Outcome in these children is primarily determined by the extent of traumatic cerebral injury and the preoperative clinical status. The latter directly depends upon diagnosis of the aneurysm prior to either initial or repeated hemorrhage.
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Affiliation(s)
- E C Ventureyra
- Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada
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19
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Reiber ME, Burkey BB. Intracavernous carotid pseudoaneurysm after blunt trauma: case report and discussion. Head Neck 1994; 16:253-8. [PMID: 8026956 DOI: 10.1002/hed.2880160308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Epistaxis following blunt facial trauma is usually self-limited and arises from the nasal mucosa, sphenopalatine, or anterior ethmoid arteries. Pseudoaneurysm of the intracavernous carotid artery (ICCA) occurs rarely with penetrating facial trauma, but is even more rare following blunt trauma. Rupture carries a greater than 50% mortality. Because rupture usually occurs after several episodes of epistaxis, recognition of subtle historic and physical findings is paramount to optimal management. Once suspicion is raised, definitive diagnosis and treatment is best accomplished with cerebral arteriogram and trapping of the pseudoaneurysm. We have noted that rupture may be precipitated by angiography, and therefore, we advocate availability of emergent and definitive treatment equipment and personnel prior to performing cerebral arteriography. This should include an otolaryngologist, an interventional radiologist, and a neurosurgeon. A case of ICCA pseudoaneurysm is presented, and the key historic factors are discussed. Radiographic diagnosis and management options are discussed.
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Affiliation(s)
- M E Reiber
- Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee 37232-2559
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20
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Romaniuk CS, Bartlett RJ, Kavanagh G, Salam MA. Case report: an unusual cause of epistaxis: non-traumatic intracavernous carotid aneurysm. A case report with 12 year follow-up and review of the literature. Br J Radiol 1993; 66:942-5. [PMID: 8220982 DOI: 10.1259/0007-1285-66-790-942] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Intracavernous carotid aneurysms are uncommon. We report the natural history and radiological appearances of a giant, non-traumatic, intracavernous carotid aneurysm which extended through the skull base to the anterior nares and caused epistaxis. The magnetic resonance imaging appearances of such an aneurysm have not been previously described. The importance of correct diagnosis is discussed.
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Affiliation(s)
- C S Romaniuk
- Department of Radiology, St James's University Hospital, Leeds, UK
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21
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Masana Y, Taneda M. Direct approach to a traumatic giant internal carotid artery aneurysm associated with a carotid-cavernous fistula. Case report. J Neurosurg 1992; 76:524-7. [PMID: 1738034 DOI: 10.3171/jns.1992.76.3.0524] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The case is reported of a giant intracranial internal carotid artery aneurysm associated with a carotid-cavernous fistula following a closed head injury. The aneurysm and the fistula disappeared after only the neck of the aneurysm was clipped. This is the first case in which a direct surgical approach was successful in sparing the internal carotid flow. Reports of similar cases are reviewed.
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Affiliation(s)
- Y Masana
- Department of Neurosurgery, Hanwa Memorial Hospital, Osaka, Japan
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22
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Linskey ME, Sekhar LN, Horton JA, Hirsch WL, Yonas H. Aneurysms of the intracavernous carotid artery: a multidisciplinary approach to treatment. J Neurosurg 1991; 75:525-34. [PMID: 1885969 DOI: 10.3171/jns.1991.75.4.0525] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Of 43 cavernous sinus aneurysms diagnosed over 6 1/2 years, 23 fulfilled indications for treatment; of these 19 were treated, eight surgically and 11 with interventional radiological techniques. Six small and two giant aneurysms were treated surgically: four were clipped, two were repaired primarily, and two were trapped with placement of a saphenous-vein bypass graft. Seven large and four giant aneurysms were treated with interventional radiological techniques: in five cases the proximal internal carotid artery (ICA) was sacrificed; one aneurysm was trapped with detachable balloons; and five were embolized with preservation of the ICA lumen. The mean follow-up period was 25 months. At follow-up examination, three patients in the surgical group were asymptomatic, two had improved, and three had worsened. Three of these patients had asymptomatic infarctions apparent on computerized tomography (CT) scans. At follow-up examination, four radiologically treated patients were asymptomatic, five had improved, two were unchanged, and none had worsened. One patient had asymptomatic and one minimally symptomatic infarction apparent on CT scans; both lesions were embolic foci after aneurysm embolization with preservation of the ICA. It is concluded that treatment risk depends more on the adequacy of collateral circulation than on the size of the aneurysm. A multidisciplinary treatment protocol for these aneurysms is described, dividing patients into high-, moderate-, and low-risk groups based on pretreatment evaluation of the risk of temporary or permanent ICA occlusion using a clinical balloon test occlusion coupled with an ICA-occluded stable xenon/CT cerebral blood flow study. Radiological techniques are suggested for most low-risk patients, while direct surgical techniques are proposed for most moderate- and high-risk patients.
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Affiliation(s)
- M E Linskey
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pennsylvania
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23
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Goleas J, Mikhael MA, Paige ML, Wolff AP. Intracavernous carotid artery aneurysm presenting as recurrent epistaxis. Ann Otol Rhinol Laryngol 1991; 100:577-9. [PMID: 2064271 DOI: 10.1177/000348949110000711] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Massive epistaxis from a leaking intracavernous carotid artery aneurysm is a rare occurrence. Such an unusual case is presented with appropriate imaging and a successful treatment program.
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Affiliation(s)
- J Goleas
- Division of Otolaryngology-Head and Neck Surgery, Evanston Hospital, Chicago, Illinois
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24
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Hahn YS, Welling B, Reichman OH, Azar-Kia B. Traumatic intracavernous aneurysm in children: massive epistaxis without ophthalmic signs. Childs Nerv Syst 1990; 6:360-4. [PMID: 2257552 DOI: 10.1007/bf00298285] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Traumatic intracavernous aneurysms are a distinctly uncommon lesion in children. They usually present with compressive symptoms of the III, IV, V, or VI cranial nerves rather than epistaxis. Epistaxis is rare and usually minor and brief in duration. A child with severe head injury and basal skull fracture, who did not have any preceding symptoms or signs of ophthalmoplegia or exophthalmus, developed massive epistaxis as a leading symptom of the ruptured intracavernous aneurysm. Since there are no reported pediatric cases with fatal epistaxis as a presenting sign, we would like to share our experience.
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Affiliation(s)
- Y S Hahn
- Department of Pediatric Neurosurgery, Loyola University Medical Center, Maywood, IL 60153
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25
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Karamoskos P, Dohrmann PJ. Traumatic internal carotid artery aneurysm and massive epistaxis. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1989; 59:745-7. [PMID: 2783098 DOI: 10.1111/j.1445-2197.1989.tb01668.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A case of traumatic internal carotid artery aneurysm (ICAA) is described. Although rare, the occurrence of rupture of traumatic ICAA with epistaxis has a high mortality. Successful management requires an awareness of the entity, prompt recognition, and aggressive first aid procedures. Definitive treatment involves trapping of the internal carotid artery either by a direct approach, or by balloon embolization.
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Affiliation(s)
- P Karamoskos
- Neurosurgery Unit, Alfred Hospital, Melbourne, Victoria, Australia
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26
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Chandy MJ, Rajshekhar V. Nontraumatic intracavernous carotid aneurysm presenting with epistaxis. J Laryngol Otol 1989; 103:425-6. [PMID: 2715703 DOI: 10.1017/s0022215100109156] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A patient with an intracavernous carotid aneurysm usually presents with symptoms and signs of a space occupying lesion, producing one of a variety of types of cavernous sinus syndromes (Jefferson, 1938). Epistaxis is an unusual feature in these patients and when present is nearly always associated with a traumatic aneurysm (Mahmoud, 1979). There are only two reported cases of non-traumatic intracavernous carotid aneurysms presenting with epistaxis and diagnosed during the lifetime of the patient (Troupp, 1962; Labayle and Legent, 1964). The authors present a third such case. The importance of considering aneurysms in the differential diagnosis of epistaxis is emphasised. The radiological investigations and management of these patients is discussed.
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Affiliation(s)
- M J Chandy
- Department of Neurological Sciences, Christian Medical College Hospital, Vellore, India
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Bousquet C, Lejeune JP, Christiaens JL. Traumatic aneurysm of the supraclinoid internal carotid artery. Case report. SURGICAL NEUROLOGY 1989; 31:319-22. [PMID: 2928928 DOI: 10.1016/0090-3019(89)90059-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A case of traumatic aneurysm of the supraclinoid portion of the internal carotid artery is reported. The diagnosis was established by angiography after delayed subarachnoid hemorrhage, 2 weeks after trauma. Surgical exploration revealed a false aneurysm and a linear defect in the posterior wall of the internal carotid artery. The vessel was repaired with a microvascular suture. Postoperative angiography demonstrated the patency of the artery.
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Affiliation(s)
- C Bousquet
- Department of Neurosurgery, Hôpital de Saint Pierre, France
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28
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Simpson RK, Harper RL, Bryan RN. Emergency balloon occlusion for massive epistaxis due to traumatic carotid-cavernous aneurysm. Case report. J Neurosurg 1988; 68:142-4. [PMID: 3335900 DOI: 10.3171/jns.1988.68.1.0142] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A patient with a giant traumatic aneurysm of the right internal carotid artery presented with recurrent massive epistaxis 30 years after a head injury. During an episode of acute hemorrhage, this patient was effectively treated with occlusion of the internal carotid artery circulation by a detachable inflatable balloon.
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Affiliation(s)
- R K Simpson
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
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Crandon IW, Teasdale E, Galbraith SL, Hadley DM. Carotid traumatic aneurysm treated by detachable balloon. Br J Neurosurg 1988; 2:507-11. [PMID: 3267335 DOI: 10.3109/02688698809029606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The authors report the case of a young man who developed a large infraclinoid carotid aneurysm following a blunt head injury and presented with epistaxis. The aneurysm was occluded by a detachable balloon resulting in a good recovery.
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Affiliation(s)
- I W Crandon
- Department of Neurosurgery, Institute of Neurological Sciences, Glasgow, United Kingdom
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