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Giant petrous carotid aneurysm: persistent epistaxis despite internal carotid artery ligation

Published online by Cambridge University Press:  13 June 2008

H Singh*
Affiliation:
Department of Otolaryngology, Singapore General Hospital, Singapore
J Thomas
Affiliation:
Department of Neurosurgery, National Neuroscience Institute, Singapore General Hospital, Singapore
W L E Hoe
Affiliation:
Department of Diagnostic Radiology, Singapore General Hospital, Singapore
D S Sethi
Affiliation:
Department of Otolaryngology, Singapore General Hospital, Singapore
*
Address for correspondence: Dr Harvinder Singh, Consultant Otolaryngologist, Rhinology Fellow, Otolaryngology Department, Singapore General Hospital, Outram Road, 169608Singapore. Fax: 6226 2079 E-mail: [email protected]

Abstract

Objectives:

We report a rare case of giant petrous carotid aneurysm.

Method:

Case report and a review of the literature regarding treatment options for such aneurysms.

Results:

A 30-year-old man presented with epistaxis, headaches and visual disturbance. Definitive diagnosis was achieved by non-invasive imaging techniques, including magnetic resonance angiography and carotid angiography. Carotid angiography demonstrated a giant petrous carotid aneurysm effacing the petrous apex. The aneurysm was obliterated by internal carotid artery ligation, following successful tolerance of the balloon occlusion test. However, despite internal carotid artery ligation, this patient continued to have minor episodes of epistaxis.

Conclusion:

Some aneurysms are too large to be treated with endovascular occlusion techniques; in such cases, ligation of the parent vessel is indicated. However, our patient continued to experience persistent, mild epistaxis despite internal carotid artery ligation, as a result of the reperfusion phenomenon.

Type
Online Only Clinical Record
Copyright
Copyright © JLO (1984) Limited 2008

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References

1Halbach, VV, Higashida, RT, Hieshima, GB. Aneurysms of the petrous portion of the internal carotid artery, results of treatment with endovascular or surgical occlusion. Am J Neuroradiol 1990;11:253–7Google ScholarPubMed
2Kudo, S, Colley, DP. Multiple intrapetrous aneurysms of the internal carotid artery. Am J Neuroradiol 1983;4:1119–21Google ScholarPubMed
3Constantino, PD, Russell, E, Reisch, D. Ruptured petrous carotid aneurysm presenting with otorrhagia and epistaxis. Am J Otol 1991;12:378–83Google Scholar
4Reece, PH, Higgins, N, Hardy, DG, Moffat, DA. An aneurysm of the petrous internal carotid artery. J Laryngol Otol 1999;113:55–7CrossRefGoogle ScholarPubMed
5Sethi, DS, Lau, DPC, Chee, LWJ, Chong, VFH. Isolated sphenoethmoid recess polyps. Otolaryngol Head Neck Surgery 1988;120:730–6CrossRefGoogle Scholar
6Moonis, G, Hwang, CJ, Ahmed, T, Weigele, JB, Hurst, RW. Otologic manifestation of petrous carotid aneurysm. Am J Neuroradiol 2005;26:1324–7Google Scholar
7Moffat, DA, O'Connor, AFF. Bilateral internal carotid aneurysms in the petrous temporal bones. Arch Otolaryngol 1980;106:172–5CrossRefGoogle ScholarPubMed
8Coley, SC, Clifton, A, Britton, J. Giant aneurysm of the petrous internal carotid artery: diagnosis and treatment. J Laryngol Otol 1998;112:196–8CrossRefGoogle ScholarPubMed
9Higashida, RT, Halbach, VV, Dowd, C, Barnwell, SL, Dormandy, B, Bell, J et al. Endovascular detachable balloon embolization therapy of cavernous carotid artery aneurysms: results in 87 cases. J Neurosurg 1990;72:857–63CrossRefGoogle ScholarPubMed
10Crow, WN, Scott, BA, Guinto, FC, Chaljub, G, Wright, G, Rabassa, AE et al. Massive epistaxis due to pseudoaneurysm treated with detachable balloons. Arch Otolaryngol 1992;118:321–4CrossRefGoogle ScholarPubMed
11Larson, JL, Tew, JM, Tomsick, TA, van Loveren, HR. Treatment of aneurysms of the internal carotid artery by intravascular balloon occlusion: long-term follow-up of 58 patients. Neurosurgery 1995;36:2330CrossRefGoogle ScholarPubMed
12Gelber, BR, Sundt, TM. Treatment of intracavernous and giant carotid aneurysms by combined internal carotid ligation and extra-to intracranical bypass. J Neurosurgery 1980;52:110CrossRefGoogle Scholar
13Cohen, S, Anastassov, GE, Chuang, SK. Posttraumatic pseudoaneurysm of the sphenopalatine artery presenting as persistent epistaxis: diagnosis and management. J Trauma 1999;47:396–9CrossRefGoogle ScholarPubMed
14Roski, R, Spettzler, R, Nulsen, K. Late complications of carotid ligation in the treatment of intracavernous aneurysms. J Neurosurgery 1981;56:583–7CrossRefGoogle Scholar