Magnetic resonance angiography follow-up examinations to detect iatrogenic pseudoaneurysms following otorhinolaryngological surgery

Abstract

Endoscopic endonasal surgery on a 36-year-old man was complicated by perforation of the right internal carotid artery. The immediate, substantial haemorrhage was controlled by packing the sphenoid sinus. Intra-arterial angiography of the right internal carotid artery showed small irregularities proximal to the ophthalmic artery. A follow-up examination two weeks later documented a large pseudoaneurysm in the initially irregular arterial segment, which was successfully treated by endovascular coiling. This case report illustrates the need for angiographic follow-up examinations following traumatic intracranial vessel injury in order to identify late pseudoaneurysm development.

Endovascular Management of Vascular Injury during Transsphenoidal Surgery

“…Similarly, another study of surgical complications in a series of 146 patients with pituitary adenomas undergoing TSS noted only a single case of PA formation 8 . In case of vascular injury during TSS, prompt recognition and emergency treatment are essential for avoiding further complications such as rupture of PA, subarachnoid or extradural hemorrhage, stroke due to thromboemboli, and even death 9,10 . In the event of intraoperative carotid injury, the carotid artery is compressed to give sufficient time for tamponade with a variety of materials (including Surgicel, muscle plugs, tissue adhesives), which are held in place by closing the sellar window with a piece of cartilage or bone.…”

“…There is a wide variety of endovascular techniques, other than PAO, which may be employed to treat vascular injuries after TSS, including coil embolization 8,10,16 , stent-assisted coiling 6,17 , covered stent placement 18 , and Onyx embolization 19 , most of which were utilized by the cases in this series. With regard to treatment with parent artery-sparing options as mentioned above, delayed-onset recanalization over the course of many months is a well-documented phenomenon that may lead to aneu- …”

Pseudoaneurysm of the internal carotid artery presenting with massive (recurrent) epistaxes: a life-threatening complication of craniofacial trauma

“…CT scan and MR provide initial information to suggest TPICA diagnosis 11,13,14 and minimally invasive imaging such as MR or CT angiography may confirm it 2,14 . However the gold standard is considered to be carotid angiography 1,2 and may provide the chance of prompt treatment by endovascular intervention.…”

“…A direct approach to the cavernous and petrous ICA is challenging because anatomic con- Endovascular treatment of the pseudoaneurysm may be with coils, stent, covered stent, or ICA balloon occlusion 6,7,9,15,16 . Embolization with detachable platinum coil, sometimes associated with stent, provides intracranial pseudoaneurysm obliteration while maintaining ICA flow 14 . However there are reports of rebleeding after coiling 14,17,18 .…”

“…Embolization with detachable platinum coil, sometimes associated with stent, provides intracranial pseudoaneurysm obliteration while maintaining ICA flow 14 . However there are reports of rebleeding after coiling 14,17,18 . The use of a covered stent allows immediate closure of the incompetent wall segment of the artery while preserving blood flow.…”