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Internal carotid artery aneurysm in skull base osteomyelitis: does the pattern of cranial nerve involvement matter?

Published online by Cambridge University Press:  12 July 2018

F Hassannia ,
S D Carr ,
E Yu  and
J A Rutka
F Hassannia*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, University Health Network, Toronto, Canada
S D Carr
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, University Health Network, Toronto, Canada
E Yu
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, University Health Network, Toronto, Canada
J A Rutka
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, University Health Network, Toronto, Canada
*
Author for correspondence: Dr Fatemeh Hassannia, Department of Otolaryngology – Head and Neck Surgery, University Health Network, Toronto, Ontario M5G 2C4, Canada E-mail: [email protected]
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Abstract

Objective

Carotid artery aneurysm is a potentially fatal complication of skull base osteomyelitis. It is important to know the warning signs for this complication, as early diagnosis is of great importance. This report aimed to determine whether the pattern of cranial nerve involvement may predict the occurrence of aneurysm involving the internal carotid artery in skull base osteomyelitis.

Methods

Two diabetic patients with skull base osteomyelitis were incidentally diagnosed with pseudo-aneurysm of the petrous internal carotid artery on follow-up magnetic resonance imaging. They presented with lower cranial nerve palsy; however, facial nerve function was almost preserved in both cases. Computed tomography angiography confirmed aneurysms at the junction of the horizontal and vertical segments of the petrous carotid artery.

Results

Internal carotid artery trapping was conducted using coil embolisation. Post-coiling magnetic resonance imaging demonstrated no procedure-related complications. Regular follow up has demonstrated that patients’ symptoms are improving.

Conclusion

One should be mindful of this potentially fatal complication in skull base osteomyelitis patients with lower cranial nerve palsies, with or without facial nerve involvement, especially in the presence of intracranial thromboembolic events or Horner's syndrome.

Keywords

PetrositisExternal OtitisCarotid ArteryPseudoaneurysmFacial Paralysis
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 132 , Issue 10 , October 2018 , pp. 929 - 931
Copyright
Copyright © JLO (1984) Limited, 2018 

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Footnotes

Dr F Hassannia takes responsibility for the integrity of the content of the paper

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