Internal carotid artery aneurysms presenting with epistaxis - our experience and review of literature

Abstract

Intraarterial digital subtraction angiography is the diagnostic modality of choice. The management of such cases is challenging due to the relative anatomical inaccessibility of the bleeding point. Management depends on the status of cross circulation. If the cross circulation is adequate, carotid sacrifice (either endovascular or surgical) is a treatment option and if it is inadequate, one is left with the options of either extracranial intracranial bypass or selective embolization of the pseudoaneurysm. We studied 4 such cases, managed surgically at our center.

Intracranial Pseudoaneurysms: Evaluation and Management

“…True aneurysms usually develop following a partial disruption of the arterial wall. The intima, internal elastic lamina, and media are damaged, whereas the adventitia is intact (1,3,8,36,37). False aneurysms or pseudoaneurysms result from disruption of the entire arterial wall (Figure 1).…”

“…Epistaxis is the common symptom of intracavernous ICA pseudoaneurysms. The intracavernous ICA is close to the sphenoid sinus, mostly bulging into the lateral sinus wall (37). A congenitally thin or even absent bony structure covering the cavernous ICA within the sphenoid sinus may provide less protection against bony erosion (42).…”

“…Due to its proximity to other cavernous structures, including cranial nerves II, III, IV, V1, V2, and VI. Traumatic ICA pseudoaneurysms may present with cranial nerve deficits, unilateral blindness, or a carotid-cavernous fistula associated to skull base fractures (9,11,37,43). Other symptoms include headache, seizures, neck rigidity, decreased mental state, paralysis, or reduced level of consciousness.…”

“…Ligation of the parent artery can result in distal ischemic complications. Moreover, it may not prevent the rupture of pseudoaneurysms due to collateral retrograde flow into the lesion (37). Trapping, in which clips are placed on the parent vessel, both proximal and distal to the aneurysm, is the definitive treatment modality to eliminate the aneurysm.…”

Carotid Pseudoaneurysm After Eversion Endarterectomy: A Case Report and Review of the Literature

“…A PA or false aneurysm is an arterial dilatation formed by an intimal tear where the aneurysm is not walled by the 3 layers, but by a blood clot or fibrous wall. 22 In most cases, it is caused by suture line disruption, usually associated with an infection. 1…”