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Petrous internal carotid artery aneurysm rupture induced by Eustachian tube catheterisation: case report. J Laryngol Otol 2022; 137:588-590. [PMID: 36203328 DOI: 10.1017/s0022215122002250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Petrous internal carotid artery aneurysms are very rare vascular lesions, which may present with otalgia and life-threatening massive otorrhoea. CASE REPORT An 84-year-old woman presented at a local otolaryngology clinic with progressive otalgia due to an acute exacerbation of chronic otitis media. She was referred with left-sided massive otorrhoea following Eustachian tube catheterisation. She suffered another massive otorrhoea with epistaxis during left-sided ear cleaning at a clinic visit. Contrast-enhanced computed tomography and computed tomography angiography revealed a left-sided aneurysm and adjacent stenosis at the left internal carotid artery. Coil embolisation of the petrous internal carotid artery aneurysm was performed with percutaneous transluminal angioplasty followed by dilatation of the stenosis. CONCLUSION Computed tomography angiography should be performed immediately when a patient reports massive otorrhoea. Endovascular occlusion is a treatment option as it avoids complications of open surgical ligation procedures.
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2
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Pingree GM, Fleming C, Reavey-Cantwell J, Coelho DH. Neurosurgical Causes of Pulsatile Tinnitus: Contemporary Update. Neurosurgery 2022; 90:161-169. [PMID: 34995248 DOI: 10.1227/neu.0000000000001778] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/31/2021] [Indexed: 12/15/2022] Open
Abstract
Traditionally in the domain of the otolaryngologist, pulsatile tinnitus (PT) has become increasingly relevant to neurosurgeons. PT may prove to be a harbinger of life-threatening pathology; however, often, it is a marker of a more benign process. Irrespectively, the neurosurgeon should be familiar with the many potential etiologies of this unique and challenging patient population. In this review, we discuss the myriad causes of PT, categorized by pulse-phase rhythmicity.
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Affiliation(s)
- Graham M Pingree
- Department of Otolaryngology - Head & Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Charles Fleming
- Department of Neurosurgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - John Reavey-Cantwell
- Department of Neurosurgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Daniel H Coelho
- Department of Otolaryngology - Head & Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
- Department of Neurosurgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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3
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Wadhavkar N, Goldrich DY, Roychowdhury S, Kwong K. Laceration of Aberrant Internal Carotid Artery Following Myringotomy: A Case Report and Review of Literature. Ann Otol Rhinol Laryngol 2021; 131:555-561. [PMID: 34192882 DOI: 10.1177/00034894211028468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The presence of an aberrant internal carotid artery (ICA) in the middle ear is rare. Patients may be asymptomatic or complain of conductive hearing loss, otalgia, pulsatile tinnitus, or aural fullness. Otoscopic exam findings can include a pulsating erythematous lesion on the tympanic membrane (TM). It may be misdiagnosed as a glomus tumor, hemangioma, or serous otitis media, or go unrecognized until surgical exploration. Early recognition is important as intraoperative discovery carries risk of iatrogenic injury, hemorrhage and subsequent neurologic sequelae. Prevention requires adequate preoperative suspicion and can be confirmed with radiologic examination via computed tomography (CT) scan or magnetic resonance angiography (MRA). Management of iatrogenic injury of an aberrant ICA can include packing, vessel embolization and/or surgical ligation. PATIENT CASE We report the case of an aberrant ICA injury in a pediatric patient undergoing a myringotomy with tube placement, who sustained neurologic deficits that eventually resolved following treatment with packing and coil embolization. DISCUSSION AND CONCLUSIONS An aberrant ICA can cause life-threatening complications without prior diagnosis in a routine myringotomy. Suspicious exam findings should prompt temporal bone CT to rule out aberrant ICA or other vascular pathology of the middle ear prior to surgery. In the case of iatrogenic injury of an aberrant ICA, there is no consensus in existing literature on optimal management. We reviewed 37 studies to compare therapeutic options and subsequent outcomes. Though complications are rare regardless of management, cases in which solely packing was utilized demonstrated an increased incidence of hemiparesis, aphasia, hearing loss, re-bleeding, and delayed pseudoaneurysm, as compared to an approach coupling packing with embolization or ligation, both of which have comparable outcomes.
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Affiliation(s)
- Neha Wadhavkar
- Department of Otolaryngology-Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - David Y Goldrich
- Department of Otolaryngology-Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Sudipta Roychowdhury
- University Radiology Group, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Kelvin Kwong
- Department of Otolaryngology-Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Boven L, Clayton S, Sorrells D, Green R, Gungor A. External carotid artery pseudoaneurysm following upper respiratory infection masquerading as a pharyngeal abscess in an 8-month-old. Am J Otolaryngol 2021; 42:102962. [PMID: 33610924 DOI: 10.1016/j.amjoto.2021.102962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/07/2021] [Indexed: 11/29/2022]
Abstract
Pseudoaneurysms are very rare with an incidence of less than 0.1% in the pediatric population. Approximately 30 cases of carotid artery aneurysms in children have been published in the literature, usually affecting children over one year of age. We present one of the youngest cases in the literature; the patient is an 8-month old female with a strep throat infection complicated by pseudoaneurysm development of the external carotid artery. Because of the rarity of these lesions, there is little known regarding the types of clinical presentation and management. They are commonly the result of direct arterial trauma; however, they can also occur secondary to infection, connective tissue disease or arteritis. We are presenting a case with a highly atypical presentation. When present, pseudoaneurysms harbor the potential risk of life-threatening hemorrhage and warrant immediate management. It is important to be aware of cases and the treatment modalities used to guide future diagnosis and planning.
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Affiliation(s)
- L Boven
- Department of Otolaryngology-H&N Surgery, Louisiana State University Health-Shreveport, 1501 King's Highway, Shreveport, LA 71130, USA.
| | - S Clayton
- Department of Surgery, Division of Pediatric Surgery, Louisiana State University Health-Shreveport, 1501 King's Highway, Shreveport, LA 71130, USA
| | - D Sorrells
- Department of Surgery, Division of Pediatric Surgery, Louisiana State University Health-Shreveport, 1501 King's Highway, Shreveport, LA 71130, USA
| | - R Green
- Department of Pediatrics, Louisiana State University Health-Shreveport, 1501 King's Highway, Shreveport, LA 71130, USA
| | - A Gungor
- Department of Otolaryngology-H&N Surgery, Louisiana State University Health-Shreveport, 1501 King's Highway, Shreveport, LA 71130, USA
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Hashim ND, Jang SH, Moon IS. Endoscopic Intervention of Aberrant Carotid Artery in the Middle Ear. Otol Neurotol 2021; 42:e82-e85. [PMID: 33156236 DOI: 10.1097/mao.0000000000002865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe surgical management for transcanal endoscopic ear surgery (TEES) in two patients with aberrant internal carotid artery (ICA) in the middle ear. PATIENTS A young girl who complained of pulsatile tinnitus and an elderly man who presented with ear bleeding. Otoendoscopy examination revealed a pulsatile reddish mass protruding through the tympanic membrane in both patients. INTERVENTIONS A combination of clinical assessments and imaging supported the diagnosis of aberrant ICA in the middle ear. Transcanal endoscopic reinforcement of the artery was performed; tragal cartilage was used as a shield to strengthen the carotid canal defect. RESULTS Assisted by fine endoscopic instruments, the protruding arteries were separated without damage to the surrounding structures and reinforced using tragal cartilage. Both patients' symptoms improved postoperatively; they reported tinnitus relief and hearing improvement. CONCLUSION To prevent catastrophic events, diagnosis of aberrant ICA is important before any surgical intervention. With appropriate management, surgical intervention using transcanal endoscopic ear surgery offers a clear view of the surgical field and is an excellent choice for management of aberrant ICA.
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Affiliation(s)
- Noor Dina Hashim
- Department of Otorhinolaryngology, U niversiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung H Jang
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - In Seok Moon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
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Anagiotos A, Kazantzi M, Tapis M. Aberrant internal carotid artery in the middle ear: the duplication variant. BMJ Case Rep 2019; 12:12/4/e228865. [PMID: 31005871 DOI: 10.1136/bcr-2018-228865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Vascular variants concerning the internal carotid artery (ICA) at the skull base level are rare. Correct workup and diagnosis in case of suspicion of such a variant are important as it mimics glomus tumours and could complicate myringotomy or middle ear surgery. We report a case of a 39-year-old woman presented with a 6-month history of right pulsatile tinnitus and aural fullness. Ear microscopy examination revealed a pale red pulsatile mass anterior to the umbo. Radiological assessment using CT and MRI/magnetic resonance angiography confirmed the diagnosis of an aberrant ICA. Interestingly, a duplication of the ICA was demonstrated, in which the enlarged inferior tympanic artery presented as the aberrant ICA, whereas a narrower collateral hypoplastic native ICA was also present. A conservative approach with regular follow-up appointments was recommended.
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Affiliation(s)
| | - Maria Kazantzi
- ENT Department, Nicosia General Hospital, Nicosia, Cyprus
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7
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Bonnard D, de Monès E, Sagardoy T, Franco-Vidal V, Darrouzet V, Fierens S. Transtympanic pseudoaneurysm of the internal carotid artery complicating a myringotomy in a four-year old child: Case report and literature review. Am J Otolaryngol 2017; 38:713-717. [PMID: 28864273 DOI: 10.1016/j.amjoto.2017.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 08/23/2017] [Indexed: 12/01/2022]
Abstract
We report the first case of a transtympanic iatrogenic internal carotid artery (ICA) pseudoaneurysm diagnosed in a 4-year-old child following a myringotomy. An endovascular treatment with a covered-stent was decided; spontaneous thrombosis was found during the therapeutic arteriography, and the procedure was aborted. Otoscopy and computed tomography (CT) scan monitoring showed a prolonged thrombosis and the disappearance of the pseudoaneurysm 18months after the diagnostic arteriography. Based on literature review, endovascular techniques seem to be preferred to the surgical approach for treatment of intrapetrous ICA pseudoaneurysm, however clinical and CT scan monitoring may also be a valid option.
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Affiliation(s)
- Damien Bonnard
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Bordeaux, Bordeaux F-33000, France.
| | - Erwan de Monès
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Bordeaux, Bordeaux F-33000, France
| | - Thomas Sagardoy
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Bordeaux, Bordeaux F-33000, France
| | - Valérie Franco-Vidal
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Bordeaux, Bordeaux F-33000, France
| | - Vincent Darrouzet
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Bordeaux, Bordeaux F-33000, France
| | - Sylvestre Fierens
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Bordeaux, Bordeaux F-33000, France
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Di Lella F, Falcioni M, Piccinini S, Iaccarino I, Bacciu A, Pasanisi E, Cerasti D, Vincenti V. Prevention and management of vascular complications in middle ear and cochlear implant surgery. Eur Arch Otorhinolaryngol 2017; 274:3883-3892. [DOI: 10.1007/s00405-017-4747-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/18/2017] [Indexed: 11/30/2022]
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9
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Takano K, Wanibuchi M, Ito F, Himi T. Pseudoaneurysm of an aberrant internal carotid artery in the middle ear caused by myringotomy. Auris Nasus Larynx 2016; 43:698-701. [DOI: 10.1016/j.anl.2016.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/11/2016] [Accepted: 03/28/2016] [Indexed: 10/22/2022]
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10
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Davis FM, Eliason JL, Ganesh SK, Blatt NB, Stanley JC, Coleman DM. Pediatric nonaortic arterial aneurysms. J Vasc Surg 2016; 63:466-76.e1. [PMID: 26804218 DOI: 10.1016/j.jvs.2015.08.099] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 08/21/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Pediatric arterial aneurysms are extremely uncommon. Indications for intervention remain poorly defined and treatments vary. The impetus for this study was to better define the contemporary surgical management of pediatric nonaortic arterial aneurysms. METHODS A retrospective analysis was conducted of 41 children with 61 aneurysms who underwent surgical treatment from 1983 to 2015 at the University of Michigan. Arteries affected included: renal (n = 26), femoral (n = 7), iliac (n = 7), superior mesenteric (n = 4), brachial (n = 3), carotid (n = 3), popliteal (n = 3), axillary (n = 2), celiac (n = 2), ulnar (n = 2), common hepatic (n = 1), and temporal (n = 1). Intracranial aneurysms and aortic aneurysms treated during the same time period were not included in this study. Primary outcomes analyzed were postoperative complications, mortality, and freedom from reintervention. RESULTS The study included 27 boys and 14 girls, with a median age of 9.8 years (range, 2 months-18 years) and a weight of 31.0 kg (range, 3.8-71 kg). Multiple aneurysms existed in 14 children. Obvious factors that contributed to aneurysmal formation included: proximal juxta-aneurysmal stenoses (n = 14), trauma (n = 12), Kawasaki disease (n = 4), Ehlers-Danlos type IV syndrome (n = 1), and infection (n = 1). Preoperative diagnoses were established using arteriography (n = 23), magnetic resonance angiography (n = 6), computed tomographic arteriography (n = 5), or ultrasonography (n = 7), and confirmed during surgery. Indications for surgery included risk of expansion and rupture, potential thrombosis or embolization of aneurysmal thrombus, local soft tissue and nerve compression, and secondary hypertension in the case of renal artery aneurysms. Primary surgical techniques included: aneurysm resection with reanastomsis, reimplantation, or angioplastic closure (n = 16), interposition (n = 10) or bypass grafts (n = 2), ligation (n = 9), plication (n = 8), endovascular occlusion (n = 3), and nephrectomy (n = 4) in cases of unreconstructable renal aneurysmal disease. Later secondary operations were required to treat stenoses at the site of the original aneurysm repairs (n = 2) and new aneurysmal development (n = 1). Postoperative follow-up averaged 47 months (range, 1-349 months). No major perioperative morbidity and no mortality was encountered in this experience. CONCLUSIONS Pediatric arterial aneurysms represent a complex disease that affects multiple vascular territories. Results of the current series suggest that individualized surgical treatment, ranging from simple ligations to major arterial reconstructions, was durable and can be undertaken with minimal risk.
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Affiliation(s)
- Frank M Davis
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich
| | - Jonathan L Eliason
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich
| | - Santhi K Ganesh
- Department of Cardiovascular Medicine, Department of Internal Medicine and Department of Human Genetics, University of Michigan, Ann Arbor, Mich
| | - Neal B Blatt
- Division of Pediatric Nephrology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Mich
| | - James C Stanley
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich
| | - Dawn M Coleman
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich.
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11
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Petri M, Dinescu V, Necula V, Cosgarea M. Otorrhagia as the initial presentation of an internal carotid artery aneurysm in the middle ear. Case presentation. ACTA ACUST UNITED AC 2016; 89:297-300. [PMID: 27152084 PMCID: PMC4849391 DOI: 10.15386/cjmed-528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/01/2015] [Accepted: 10/10/2015] [Indexed: 11/23/2022]
Abstract
Middle ear aneurysms are rare and difficult to treat. The case of a 50-year-old female who presented with left otorrhagia caused by an internal carotid aneurysm is reported. She had no medical history of tinnitus, vertigo, otalgia or otorrhea. Middle ear surgery was effective in resolving bleeding and did not cause any permanent neurological deficit. High resolution computed tomography angiography is the technique of choice and, in some cases, can be complemented with a magnetic resonance angiography. Misdiagnosis of the internal carotid artery aneurysm may lead to serious morbidity because of bleeding or vascular occlusion. The use of modern imaging techniques explain the current relative increase in frequency.
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Affiliation(s)
- Maria Petri
- ENT Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Veronica Dinescu
- ENT Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Violeta Necula
- ENT Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Marcel Cosgarea
- ENT Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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12
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The relationship between tinnitus and vascular anomalies on temporal bone CT scan: a retrospective case control study. Surg Radiol Anat 2016; 38:835-41. [PMID: 26831324 DOI: 10.1007/s00276-016-1629-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 01/18/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Tinnitus is a common symptom in which etiology is unclear in a group of patients. Some of anatomic or vascular variations diagnosed on temporal bone computed tomography (CT) has been known to cause tinnitus particulary pulsatile form. Therefore significance of these anatomic variations has not been validated in patients with nonpulsatile tinnitus. The aim of this study is to ascertain several anatomic variations previously attributed to pulsatile tinnitus in nonpulsatile tinnitus patients. And secondly to assess the relationship between the amount of sigmoid sinus bulging and mastoid emissary vein (MEV), enlargement of those was not evaluated before in tinnitus patients. METHODS Retrospectively, temporal bone CT scans of 70 patients with an existing complaint of tinnitus with unexplained etiology were enrolled. As a control group, 70 patients were selected from paranasal sinus CT scans without any otological or clinical findings. RESULTS The type of tinnitus was subjective and nonpulsatile in the overall group. The diameters of enlarged MEV on the left side were significantly higher in the tinnitus group. Carotid canal dehiscence and high riding jugular bulb were significantly higher in the tinnitus patients. Petrous bone pneumatization was significantly lower in the tinnitus patients than in the control group. CONCLUSIONS In patients who complained of subjective nonpulsatile tinnitus with unknown etiology, some temporal bone vascular variations, including high riding jugular bulb, dehiscent carotid canal, left-sided MEV enlargement, and petrous bone pneumatization, seemed to have an association with tinnitus. Further studies comparing all these entities between pulsatile and nonpulsatile groups and healthy controls should be undertaken.
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Pseudoaneurysm of the Common Carotid Artery in an Infant due to Swallowed Fish Bone. Case Rep Radiol 2015; 2015:903150. [PMID: 26783485 PMCID: PMC4689903 DOI: 10.1155/2015/903150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 12/01/2015] [Indexed: 02/06/2023] Open
Abstract
Carotid artery pseudoaneurysm is a rare condition, particularly in the paediatric population. Only about 30 cases of carotid artery aneurysms in infants have been published until now. This paper reports the case of a giant pseudoaneurysm of the left common carotid artery due to swallowed fish bone by an 8-year-old boy. This pseudoaneurysm was 5.5 cm transverse-diameter and resulted in severe respiratory distress. It was treated by resection and end-to-end anastomosis with satisfactory outcome after one-year follow-up. To the best of our knowledge, this is the largest carotid artery pseudoaneurysm ever described in children.
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Choi SH, Park H, Yang TK, Song CI. Pseudoaneurysm of the Petrosal Internal Carotid Artery in the Middle Ear as a Complication of Middle Ear Cholesteatoma. J Audiol Otol 2015; 19:58-61. [PMID: 26185794 PMCID: PMC4491941 DOI: 10.7874/jao.2015.19.1.58] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/05/2015] [Accepted: 03/27/2015] [Indexed: 11/22/2022] Open
Abstract
We report the case of a 66-year-old man who had significant otorrhagia caused by a ruptured pseudoaneurysm in the petrous internal carotid artery (ICA). The patient had middle ear cholesteatoma, and computed tomography (CT) showed bony erosion and exposure of the ICA into the middle ear cavity. Further angiography of the right carotid artery revealed a pseudoaneurysm protruding from the petrosal ICA into the middle ear cavity. The pseudoaneurysm was promptly treated with coil embolization and stenting. The patient continues to be monitored regularly with clinical follow-up, and carotid angiography and temporal bone CT revealed no interval changes at the embolized site 3 years after the procedure.
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Affiliation(s)
- Seung Hyo Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Jeju National University Hospital, Jeju, Korea
| | - Hyun Park
- Department of Neurosurgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Tae Ki Yang
- Department of Neurosurgery, Jeju National University Hospital, Jeju, Korea
| | - Chan Il Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Jeju National University Hospital, Jeju, Korea
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15
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Rangel-Castilla L, McDougall CG, Spetzler RF, Nakaji P. Urgent cerebral revascularization bypass surgery for iatrogenic skull base internal carotid artery injury. Neurosurgery 2015; 10 Suppl 4:640-7; discussion 647-8. [PMID: 25181433 DOI: 10.1227/neu.0000000000000529] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND When feasible, the management of iatrogenic internal carotid artery (ICA) injury during skull base surgery is mainly endovascular. OBJECTIVE To propose a cerebral revascularization procedure as a rescue option when endovascular treatment is not feasible. METHODS We retrospectively reviewed all extracranial-intracranial (EC-IC) bypass procedures performed between July 2007 and January 2014. RESULTS From 235 procedures, we identified 8 consecutive patients with iatrogenic ICA injury managed with an EC-IC bypass. Injury to the ICA occurred during an endoscopic transsphenoidal surgery (n=3), endoscopic transfacial-transmaxillary surgery (n=1), myringotomy (n=1), cavernous sinus meningioma resection (n=1), posterior communicating artery aneurysm clipping (n=1), and cavernous ICA aneurysm coiling (n=1). Endovascular management was considered first-line treatment but was not successful. All patients received a high-flow EC-IC bypass. At a mean clinical/radiographic follow-up of 19 months (range, 3-36 months), all patients had a modified Rankin Scale score of 0 or 1. All bypasses remained patent. CONCLUSION Iatrogenic injury of the skull base ICA is uncommon but can lead to lethal consequences. Many injuries can be treated with endovascular techniques. However, certain cases may still require a cerebral revascularization procedure.
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Affiliation(s)
- Leonardo Rangel-Castilla
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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16
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Schutt C, Dissanaike S, Marchbanks J. Case report: inadvertent carotid artery injury during myringotomy as a result of carotid artery dehiscence. EAR, NOSE & THROAT JOURNAL 2014; 92:E35-7. [PMID: 23904315 DOI: 10.1177/014556131309200720] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report the case of a 3-year-old girl whose internal carotid artery was pierced during a myringotomy. Postoperative computed tomography demonstrated that the complication was caused by a dehiscent carotid canal wall; contralateral dehiscence was also present. The patient had previously received two sets of middle ear ventilation tubes with no complications. This article addresses the epidemiology and anatomy of carotid dehiscence, and discusses methods to potentially prevent this complication, including screening and imaging modalities.
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Affiliation(s)
- Christopher Schutt
- Department of Surgery, Section of Otolaryngology, Yale University, New Haven, CT 06520-8041, USA.
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17
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Conley RN, Longmuir GA. Brain and Spinal Cord. Clin Imaging 2014. [DOI: 10.1016/b978-0-323-08495-6.00033-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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18
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OYAMA H, HATTORI K, TANAHASHI S, KITO A, MAKI H, TANAHASHI K. Ruptured Pseudoaneurysm of the Petrous Internal Carotid Artery Caused by Chronic Otitis Media -Case Report-. Neurol Med Chir (Tokyo) 2010; 50:578-80. [DOI: 10.2176/nmc.50.578] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Akira KITO
- Department of Neurosurgery, Ogaki Municipal Hospital
| | - Hideki MAKI
- Department of Neurosurgery, Ogaki Municipal Hospital
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19
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Saylam G, Tulgar M, Saatci I, Korkmaz H. Iatrogenic carotid artery pseudoaneurysm presenting with conductive hearing loss. Am J Otolaryngol 2009; 30:141-4. [PMID: 19239957 DOI: 10.1016/j.amjoto.2008.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Accepted: 08/03/2008] [Indexed: 11/26/2022]
Abstract
Pseudoaneurysms of the intracranial internal carotid artery may occur in the setting of carotid artery dehiscence, due to trauma, invasive tumors, or as a complication of surgery. The rare surgical complication of carotid artery laceration in the petrous segment may occur during myringotomy procedures, middle ear operations, or petrous temporal bone surgery. We report a 28-year-old female patient, a case of internal carotid artery pseudoaneurysm as a complication of middle ear surgery. On her follow-up, computed tomography of the temporal bone demonstrated a dehiscent carotid artery, and a pseudoaneurysm involving the left petrous internal carotid artery was found in the cerebral angiography. She was managed by endovascular means.
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Pourhassan S, Grotemeyer D, Fokou M, Heinen W, Balzer K, Ramp U, Sandmann W. Extracranial carotid arteries aneurysms in children: single-center experiences in 4 patients and review of the literature. J Pediatr Surg 2007; 42:1961-8. [PMID: 18022458 DOI: 10.1016/j.jpedsurg.2007.07.052] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Revised: 07/21/2007] [Accepted: 07/21/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Extracranial carotid artery aneurysms (ECAAs) are very rare conditions in children but carry a great potential of thromboembolic episodes and ruptures. METHODS To determine the clinical and therapeutic characteristics of ECAA in children in our department, we reviewed the patients' records and completed the data from phone correspondence, written survey, and clinical examination. RESULTS From January 1981 to June 2006, 4 patients younger than 18 years were surgically treated for ECAA in our department. They were 3 boys and 1 girl. A medical history of tonsillectomy was reported in 3 patients. The aneurysm was symptomatic in all of the patients, local signs being present in every patient. The aneurysm caused hemispheric symptoms in 1 patient and finally stroke. The aneurysms were located in the common carotid artery, in the external carotid artery, and 2 in the internal carotid artery. The cause was congenital, mycotic, and traumatic (post tonsillectomy); for 1 patient, the etiology remained unknown. Aneurysm resection and interposition with vein graft were performed in 3 patients. The external carotid artery aneurysm was resected without reconstruction. There was no perioperative death or stroke. During the early follow-up period, 1 patient had a transient dysphagia and another a transient facial palsy. The patient with preoperative stroke remained with a neurologic deficit. All these patients were followed since the operation. The patient operated on in 1981 is asymptomatic after 25 years, but the graft became occluded 3 years after the operation. The patient who had recurrent attacks is still with residual neurologic deficit. The 2 other patients are without complains; the reconstructions remain patent. CONCLUSION Although very rare, ECAA can be encountered even in the pediatric population. The past medical history may reveal a tonsillectomy, although the relation may not be easy to establish. Local signs may be accompanied by hemispheric thromboembolic complications, rupture, and bleeding. Therefore, surgical treatment is indicated, but can be challenging according to the anatomical location of the aneurysm.
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Affiliation(s)
- Siamak Pourhassan
- Department of Vascular Surgery and Kidney Transplantation, University Hospital, 40225 Düsseldorf, Germany
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Cohen JE, Grigoriadis S, Gomori JM. Petrous carotid artery pseudoaneurysm in bilateral carotid fibromuscular dysplasia: treatment by means of self-expanding covered stent. ACTA ACUST UNITED AC 2007; 68:216-20; discussion 220. [PMID: 17537488 DOI: 10.1016/j.surneu.2006.08.082] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Accepted: 08/25/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pseudoaneurysms of the petrous carotid artery may occur in the setting of trauma, dissection, invasive tumors, or as a complication of surgery. These aneurysms may grow and constitute a potential source of thromboembolic complications or rupture. CASE DESCRIPTION We present a patient with bilateral carotid FMD presenting with a large petrous pseudoaneurysm. Because carotid occlusion was not appropriate, a self-expandable covered stent was implanted. This treatment allowed complete exclusion of the pseudoaneurysm and preservation of the parent artery. CONCLUSION The accepted treatment of psuedoaneurysms located at petrous ICA is either sacrifice of the carotid artery or exclusion of the aneurysm from the preserved carotid artery. These procedures have specific limitations, and they are technically demanding and associated with a substantial morbidity rate. The endovascular treatment of these lesions is the preferred alternative. Among the various endovascular techniques that have been tested so far, we propose self-expandable covered stents as ideal for treating arterial aneurysms and pseudoaneurysms of the petrous and cavernous carotid segments.
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Affiliation(s)
- José E Cohen
- Department of Neurosurgery, Hadassah Stroke Center, Section of Endovascular Neurosurgery and Interventional Neuroradiology, Hadassah University Hospital, Jerusalem 91120, Israel
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Inamasu J, Guiot BH. Iatrogenic carotid artery injury in neurosurgery. Neurosurg Rev 2005; 28:239-47; discussion 248. [PMID: 16091974 DOI: 10.1007/s10143-005-0412-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2005] [Revised: 06/08/2005] [Accepted: 07/15/2005] [Indexed: 11/25/2022]
Abstract
Iatrogenic carotid artery injury (CAI) results from various neurosurgical procedures. A review of the literature was conducted to provide an update on the management of this potentially devastating complication. Iatrogenic CAIs are categorized according to each diagnostic or therapeutic procedure responsible for the injury, i.e., anterior cervical spine surgery, central venous catheterization, chemical substances, chiropractic manipulation, diagnostic cerebral angiography, middle-ear surgery, percutaneous procedures for trigeminal neuralgia, radiation therapy, skull-base surgery, tracheostomy, and transsphenoidal surgery. The incidence, mechanisms of injury, diagnostic imaging modalities, and reparative procedures are discussed for each procedure. Iatrogenic CAI may be more prevalent than had previously been thought, mostly because of a heightened awareness on the part of physicians and the earlier detection of asymptomatic patients owing to sophisticated and less-invasive imaging modalities. Prevention is the best treatment for every iatrogenic injury, and it is expected that further accumulation of experience with and knowledge of iatrogenic CAI will result in further reduction of this complication. Although some CAIs, such as radiation-induced carotid artery stenosis, may not be preventable, earlier intervention before the patient becomes symptomatic may favorably alter the prognosis. Following the rapid development of endovascular techniques in recent years, surgically inaccessible lesions can be treated in a more reliable and safe manner than before.
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Affiliation(s)
- Joji Inamasu
- Department of Neurosurgery, University of South Florida College of Medicine, Room 730, Harbourside Medical Tower, 4 Columbia Dr., Tampa, FL 33606, USA.
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Hasebe S, Sando I, Orita Y. Proximity of carotid canal wall to tympanic membrane: a human temporal bone study. Laryngoscope 2003; 113:802-7. [PMID: 12792314 DOI: 10.1097/00005537-200305000-00007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective was to examine the possible risk of injury to the internal carotid artery during procedures in the middle ear, including myringotomy. STUDY DESIGN Histopathological morphometric study of human temporal bones. METHODS One hundred forty-two human temporal bone specimens obtained from 92 individuals without any known ear disease were prepared for light microscopic study. Using 83 bones that were available for measurement, the thickness of the carotid canal wall (CCW), which is the medial wall of the bony portion of the eustachian tube, was measured. Using 15 bones selected for three-dimensional measurement, the closest distance from CCW to the anterior tympanic annulus was measured. Using all 142 temporal bone specimens, the CCW was examined to detect the presence of partial dehiscence. In one case, the images of CCW dehiscence and its surrounding structures were reconstructed by a personal computer. RESULTS The thickness of the CCW was 0.00 to 0.73 mm (average thickness, 0.24 mm [+/-0.12 mm]). The distance from the CCW to the anterior tympanic annulus was 1.8 to 8.1 mm (average distance, 4.9 [+/-1.7 mm]). Dehiscence of CCW was observed in 7 (4.9%) of 142 temporal bone specimens. The reconstructed image showed that the posterior half of the dehiscence of CCW could be seen from the external ear canal. CONCLUSIONS The CCW was found to be extremely thin or even dehiscent in some cases, rendering the internal carotid artery vulnerable during transtympanic procedures. The study's findings emphasized the need for judicious care when operating in the anterior mesotympanum.
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Affiliation(s)
- Seishi Hasebe
- Division of Otopathology, University of Pittsburgh School of Medicine, Pennsylvania 15213, USA
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Rojas R, Palacios E, D'Antonio M, Correa G. Aberrant Internal Carotid Artery as a Cause of Pulsatile Tinnitus and an Intratympanic Mass. EAR, NOSE & THROAT JOURNAL 2003. [DOI: 10.1177/014556130308200306] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Rafael Rojas
- Department of Radiology, Louisiana State University Health Science Center, New Orleans
| | - Enrique Palacios
- Department of Radiology, Louisiana State University Health Science Center, New Orleans
| | - Michael D'Antonio
- Department of Radiology, Louisiana State University Health Science Center, New Orleans
| | - Gonzalo Correa
- Department of Radiology, Louisiana State University Health Science Center, New Orleans
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Jain R, Marotta TR, Redekop G, Anderson DW. Management of aberrant internal carotid artery injury: a real emergency. Otolaryngol Head Neck Surg 2002; 127:470-3. [PMID: 12447247 DOI: 10.1067/mhn.2002.129818] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Rajan Jain
- Department of Radiology, Vancouver General Hospital, British Columbia, Canada
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Chambers N, Hampson-Evans D, Patwardhan K, Murdoch L. Traumatic aneurysm of the internal carotid artery in an infant: a surprise diagnosis. Paediatr Anaesth 2002; 12:356-61. [PMID: 11982845 DOI: 10.1046/j.1460-9592.2002.00831.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Isolated aneurysm of the extracranial section of the internal carotid artery has been reported in children but never, to our knowledge, in an infant. It can represent a major anaesthetic challenge with compromise of both airway and cerebral perfusion and the associated risks of rupture. We report on an 11-month-old infant, who had undergone an examination under anaesthesia of her nose and throat for epistaxis and gastrointestinal endoscopy due to apparent gastrointestinal bleeding shortly before presenting to us with signs of rapidly progressive upper airway obstruction. Emergency examination under anaesthesia revealed a large pulsatile mass in the posterior nasopharynx which, on subsequent radiological investigation, was revealed to be a large pseudoaneurysm of the right internal carotid artery, obstructing distal flow. An apparently minor episode of trauma had occurred around the time of the first nosebleed; she had allegedly fallen onto her face with a spoon in her mouth.
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Affiliation(s)
- Neil Chambers
- Department of Anaesthesia and Paediatric Intensive Care, St George's Healthcare NHS Trust, Tooting, London, UK
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Alexander MJ, Smith TP, Tucci DL. Treatment of an Iatrogenic Petrous Carotid Artery Pseudoaneurysm with a Symbiot Covered Stent: Technical Case Report. Neurosurgery 2002. [DOI: 10.1227/00006123-200203000-00047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Alexander MJ, Smith TP, Tucci DL. Treatment of an iatrogenic petrous carotid artery pseudoaneurysm with a Symbiot covered stent: technical case report. Neurosurgery 2002; 50:658-62. [PMID: 11841739 DOI: 10.1097/00006123-200203000-00047] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE Surgery involving the middle ear or the temporal bone may cause an injury to the petrous carotid artery resulting in a pseudoaneurysm. Conventional treatment of such pseudoaneurysms has ranged from carotid occlusion to conservative management. The use of a balloon-expandable stent and/or Guglielmi detachable coils may be effective in a partially healed pseudoaneurysm. This report details the case of an acute petrous carotid pseudoaneurysm after a myringotomy procedure that was effectively treated with an expanded polytetrafluoroethylene-covered stent. CLINICAL PRESENTATION During a right myringotomy procedure, pulsatile blood was encountered in a 42-year-old woman with a history of repeated ear infections and bilateral middle ear ventilation tube placement. The blood was adequately tamponaded with gauze packing. Computed tomography of the temporal bone demonstrated a dehiscent carotid artery, and cerebral angiography revealed a 6-mm right petrous carotid pseudoaneurysm. INTERVENTION/TECHNIQUE An 8-French guide catheter was positioned via a transfemoral approach into the cervical right internal carotid artery, and the patient was systemically heparinized. A 4- x 31-mm Symbiot covered stent (Boston Scientific/Scimed, Maple Grove, MN) was passed over a Choice PT exchange wire (Boston Scientific/Scimed) to cover the neck of the pseudoaneurysm, obliterating the pseudoaneurysm. The patient was given aspirin and clopidogrel after stenting, and ear exploration was possible later the same day. Follow-up computed tomographic angiography performed 6 weeks later verified patency of the stent. CONCLUSION The use of an expanded polytetrafluoroethylene-covered stent may effectively treat intracranial internal carotid artery pseudoaneurysms in an acute setting. This treatment allows preservation of the parent artery and immediate treatment by reconstruction of the incompetent arterial wall to prevent potentially life-threatening hemorrhagic complications.
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Affiliation(s)
- Michael J Alexander
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Ridder GJ, Fradis M, Schipper J. Aberrant internal carotid artery in the middle ear. Ann Otol Rhinol Laryngol 2001; 110:892-4. [PMID: 11558768 DOI: 10.1177/000348940111000915] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- G J Ridder
- Department of Otorhinolaryngology-Head and Neck Surgery, University Clinic Freiburg, Germany
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