Severe Epistaxis Caused by Ruptured Aneurysm of the Internal Carotid Artery

Giant intracavernous internal carotid artery aneurysm with fatal epistaxis

“…The second is a traumatic, younger group in the second to fourth decade of life, usually healthy males, with severe head injury most commonly from major trauma (Mahmoud, 1979). In the former group, whose aneurysms are thought to be congenital (McCormick and Beals, 1964), epistaxis may occur, whereas in the latter group, epistaxis is almost invariable, but delayed. CICAAs from both groups may expand over time giving rise to giant aneurysms, which, by definition, are greater than 2.5 cm in diameter.…”

“…They may affect the adjacent vascular, nervous, and bony elements and extend into surrounding paranasal structures by erosion of the base of the skull (Romaniuk et al, 1993). A number of fatalities have been reported in the traumatic group, all demonstrating extensive erosion of the base of the skull with extracranial extension (Seftel et al, 1959;Araki et al, 1964;McCormick and Beals, 1964;Steinmetz et al, 1988;Han et al, 1994). Fewer with non-fatal outcomes have been documented (Romaniuk et al, 1993).…”

Balloon catheter occlusion for cavernous carotid artery injury during transsphenoidal hypophysectomy

“…The risk of delayed definitive treatment is exemplified by one patient in whom massive epistaxis resulted in his death prior to scheduled surgical repair. 16 Successful definitive treatment for this problem has included carotid ligation,12,24,30 gradual ICA occlusion using a Selverstone 2 or Crutchfield clamp,11 and trapping procedures I3 ,15,19,20,26,28,31 described by Hamby.7,8 There has been one unsuccessful attempt at balloon obliteration. 15 Standard carotid-cavernous fistulas can be managed with balloon catheter occlusion,3,15,21,22 direct repair using hypothermic cardiac arrest,18 trapping procedures,7,8 or electrothrombosis.…”

“…However, symptomatic false aneurysm formation has often developed subsequently, and recurrent, and often massive, epistaxis has occurred with rupture of the aneurysm. 2,12,13,15,16,20,24,[26][27][28]30,31 Carotid-cavernous fistulas developed in a few patients. 15 ,19,31 Epistaxis was more common than carotid-cavernous fistula formation, since the wall of the cavernous sinus was also tom.…”

“…2 ,5,6,11,19,24,30 Iatrogenic cavernous carotid injury has been reported to occur during paranasal sinus operations,12,15,24,29,31 thromboendarterectomy,4 and percutaneous radiofrequency trigeminal rhizotomy.25 Tears of the ICA at this site have also been reported due to head trauma. 13,16,20,[26][27][28] Anatomical studies have shown that the two cavernous carotid arteries can approach within 4 mm of one another in the sella turcica. 1 ,23 In a study by Bergland, et al/ 22% of the human specimens examined demonstrated distortion of the lateral pituitary gland by the carotid artery.…”