Traumatic aneurysm of the internal carotid artery

Abstract

Epistaxis complicating a severe craniofacial injury is not unusual, but in most cases bleeding is easily controlled by nasal packs. On the other hand, epistaxis as a major manifestation of traumatic aneurysm of the internal carotid artery is reported to be rare. When this occurs, however, prognosis is grave and the treatment creates a perplexing nenrosurgical problem.In the case of penetrating injury involving the head and face, the correct diagnosis of the source of bleeding is usually made. When the epistaxis occurs weeks after the closed head injury, however, its direct relation to the previous injury is often not so apparent and easily escapes the attention of both patient and physician. In fact, causal relationship between preceding trauma and present epistaxis is only occasionally identified when the patient is first seen with an epistaxis from a traumatic aneurysm of the internal carotid artery.We have treated four consecutive cases of traumatic aneurysm of the internal carotid artery. Two of them came under our care in a one month period. From this experience, we are inclined to believe that traumatic aneurysm of the internal carotid artery is less rare than previous reports would indicate. It is this belief that prompted the present article.In all four cases the aneurysm was verified either by carotid angiography or at autopsy, or both. In three of them, severe recurrent epistaxis was observed. In the remaining one, delayed epistaxis was absent but this ease is of particular interest as the aneurysm was associated with a homolateral carotieocavernous fistula and both of them were followed up by means of repeat angiographic studies over several months. Report of CasesCase I: Tra]]ic accident. Epidural haematoma evacuated. Severe ~'ecurrent epistaxis. Exsanguination. Autopsy. G. M., a 19-year-old man, was involved in a traffic accident. A depressed fracture in the left frontal region, linear fractures in the right frontal and Act~ Neurochirurgica, Vol. XVII, Fast. 3 II

Traumatic aneurysm of the supraclinoid internal carotid artery and an associated carotid—cavernous fistula: vascular reconstruction performed using intravascular implantation of stents and coils

“…1,4,27,29,34,35 Even rarer is the concomitant appearance of a traumatic intracranial aneurysm and a CCF due to head injury. 4,14,20,23,25,26,30,31,39,40 To the best of our knowledge, only five cases of traumatic aneurysm arising from the supraclinoid segment of the ICA in association with a CCF secondary to head trauma have been reported. 4,17,23,31,39 Traumatic intracranial aneurysms have been reported following penetrating, nonpenetrating, or iatrogenic vascular injuries.…”

“…2,4,8,27,29,[32][33][34] In our case, the diagnosis of traumatic aneurysm was made 11 days after trauma, which prompted us to treat this lesion as soon as possible. Various techniques for the management of traumatic aneurysms of the supraclinoid ICA have been described, including ICA trapping, 2,4,9,14 ligation of the CA in the neck, 29,34,38 IC balloon occlusion, 33 and direct clip occlusion of the aneurysm neck or aneurysm excision with microsurgical repair. 5,10 The five reported cases of traumatic aneurysm of the supraclinoid ICA associated with CCF were treated by trapping the aneurysm and sacrificing the parent artery 4,17,31,39 or by clipping the aneurysm neck via a direct surgical approach.…”

Traumatic Cerebral Aneurysm Associated with a Contralateral Traumatic Carotid Cavernous Fistula

“…Traumatic intracranial aneurysms are rare, accounting for less than 1% of intracranial aneurysms 2,12 , although vascular injuries were found to be 25% in patients carefully screened with facial bone fracture, closed head injury, or a history of serious hyperextension-rotation mechanism 13. The concomitant appearance of a traumatic intracranial aneurysm and a CCF secondary to head trauma is rare 4,5,15,16,7,17 . Furthermore, no case of T-CCF associated with a contralateral TCA due to head injury has been reported.…”

Traumatic Lesions of the Bilateral Middle Meningeal Arteries. Case Report.

“…6) A case with epistaxis may be fatal. 2) If a patient presents with anterior skull base fracture extending to the anterior clinoid process and unilateral vision disorder, we suspect traumatic injury of the internal carotid artery and perform magnetic resonance angiography or cerebral angiography. In this case, we performed cerebral angiography which revealed the pseudoaneurysm of the left middle meningeal artery and dural arteriovenous fistula of the right middle meningeal artery, both consistent in location with the bilateral fractures.…”