Cavernous carotid artery pseudo-aneurysm treated by stenting in acromegalic patient

Souza, Jorge Marcondes de; Domingues, Flavio S.; Espinosa, Gaudêncio; Gadelha, Mônica R.

doi:10.1590/s0004-282x2003000300025

Cited by 20 publications

(6 citation statements)

References 13 publications

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“…17 The use of a flow-iverting stent may obviate the need for an intra-aneurysmal embolization. 18,25 However, flow-diverting stents surrender future endovascular access to the pseudoaneurysm, because once deployed a microcatheter cannot be passed through it. If the patient experiences breakthrough bleeding, he or she could not be treated with further embolic agents.…”

Section: Discussionmentioning

confidence: 99%

Delayed Cavernous Carotid Artery Pseudoaneurysm Caused by Absorbable Plate Following Transsphenoidal Surgery: Case Report and Review of the Literature

et al. 2013

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Background Bioabsorbable plates are frequently utilized in the repair of skull base defects following transsphenoidal operations. Traumatic intracranial pseudoaneurysms are a rare complication of transsphenoidal surgery. To date, iatrogenic carotid pseudoaneurysm associated with the use of an absorbable plate has been reported once.Results A 57-year-old man with a large nonfunctional pituitary macroadenoma underwent an endoscopic transsphenoidal operation with gross total resection. An absorbable plate was placed extradurally to reconstruct the sellar floor. He experienced delayed repeated epistaxis, followed by a right middle cerebral artery distribution embolic stroke. Computed tomorgraphy (CT) angiogram 6 weeks postoperatively revealed a 6 × 4 mm pseudoaneurysm located on the medial wall of the right cavernous internal carotid artery. Stent coiling was used to successfully obliterate the pseudoaneurysm, and the patient fully recovered.Conclusion Delayed erosion of the carotid artery wall caused by a plate used to reconstruct the sellar floor may manifest with epistaxis or embolic stroke. The authors' preference is to avoid insertion of a rigid plate for sellar floor reconstruction in the absence of intraoperative cerebrospinal fluid (CSF) leaks, unless it is required to buttress a large skull base defect. Short-segment embolization with stent coiling is the preferred treatment option for carotid pseudoaneurysms following transsphenoidal operations.

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Section: Discussionmentioning

confidence: 99%

Delayed Cavernous Carotid Artery Pseudoaneurysm Caused by Absorbable Plate Following Transsphenoidal Surgery: Case Report and Review of the Literature

et al. 2013

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“…A literature review and the current series identified 31 cases that received endovascular ICA endoluminal recon-struction. Techniques included covered stent placement (24 cases), 19,22,24,30,32,43,44,47,51,54,74,76,83,85 multiple uncovered stents (1), 29 flow diversion (5), 4,62 and stenting method not reported (1) 16 (Table 4). Injury types included pseudoaneurysms (16 cases), active bleeding (12), CCF (2), and aneurysm laceration (1).…”

Section: Analysis Of Institutional and Literature Casesmentioning

confidence: 99%

Endovascular management of internal carotid artery injuries secondary to endonasal surgery: case series and review of the literature

Sylvester¹,

Moran

Derdeyn

et al. 2016

JNS

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OBJECTIVE Internal carotid artery (ICA) injury is a rare but severe complication of endonasal surgery. The authors describe their endovascular experience managing ICA injuries after transsphenoidal surgery; they review and summarize the current literature regarding endovascular techniques; and they propose a treatment algorithm based on the available evidence. METHODS A retrospective review of 576 transsphenoidal pituitary adenoma resections was performed. Cases of ICA injury occurring at our institution and transfers from other hospitals were evaluated. Endovascular treatments for ICA injury reported in the literature were also reviewed and summarized. RESULTS Seven cases were identified from the institutional cohort (mean age 46.3 years, mean follow-up 43.4 months [1-107 months]) that received endovascular treatment for ICA injury. Five injuries occurred at our institution (5 [0.9%] of 576), and 2 injuries occurred at outside hospitals. Three patients underwent ICA sacrifice by coil placement, 2 underwent lesion embolization (coil or stent-assisted coil placement), and 2 underwent endoluminal reconstruction (both with flow diversion devices). Review of the literature identified 98 cases of ICA injury treated with endovascular methods. Of the 105 total cases, 46 patients underwent ICA sacrifice, 28 underwent lesion embolization, and 31 underwent endoluminal reconstruction. Sacrifice of the ICA proved a durable solution in all cases; however, the rate of persistent neurological complications was relatively high (10 [21.7%] of 46). Lesion embolization was primarily performed by coil embolization without stenting (16 cases) and stent-assisted coiling (9 cases). Both techniques had a relatively high rate of at least some technical complication (6 [37.5%] of 16 and 5 [55.6%] of 9, respectively) and major technical complications (i.e., injury, new neurological deficit, or ICA sacrifice) (5 [31.3%] of 16 and 2 [22.2%] of 9, respectively). Endoluminal reconstruction was performed by covered stent (24 cases) and flow diverter (5 cases) placement. Covered stents showed a reasonably high rate of technical complications (10 [41.7%] of 24); however, 8 of these problems were resolved, leaving a small percentage with major technical complications (2 [8.3%] of 24). Flow diverter placement was also well tolerated, with only 1 minor technical complication. CONCLUSIONS Endovascular treatments including vessel sacrifice, coil embolization (with or without stent assistance), and endoluminal reconstruction offer a tailored approach to ICA injury management after endonasal surgery. Vessel sacrifice remains the definitive treatment for acute, uncontrolled bleeding; however, vessel preservation techniques should be considered carefully in select patients. Multiple factors including vascular anatomy, injury characteristics, and risk of dual antiplatelet therapy should guide best treatment, but more study is needed (particularly with flow diverters) to refine this decision-making process. Ideally, all endovascular treatment options should...

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“…The endoscopic understanding of the ICA is important because of the increased use of endoscopic approaches to the base of the skull that may cause ICA injury or pseudoaneurysm after ventral endoscopic approaches. [2569101317181920212223242526272829] The numerical classification systems may be confusing because of changes in the numerical systems based on updated findings. In proposing the present classification system, we added information about associated structures to each segment, based on detailed statistical analysis, which may be valuable in alerting the surgeon about structures at risk, depending on the surgical zone, during lateral microsurgical or ventral endoscopic procedures [Table 3].…”

Section: Discussionmentioning

confidence: 99%

Proposed clinical internal carotid artery classification system

Abdulrauf

Ashour

Marvin

et al. 2016

J Craniovert Jun Spine

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Introduction:Numerical classification systems for the internal carotid artery (ICA) are available, but modifications have added confusion to the numerical systems. Furthermore, previous classifications may not be applicable uniformly to microsurgical and endoscopic procedures. The purpose of this study was to develop a clinically useful classification system.Materials and Methods:We performed cadaver dissections of the ICA in 5 heads (10 sides) and evaluated 648 internal carotid arteries with computed tomography angiography. We identified specific anatomic landmarks to define the beginning and end of each ICA segment.Results:The ICA was classified into eight segments based on the cadaver and imaging findings: (1) Cervical segment; (2) cochlear segment (ascending segment of the ICA in the temporal bone) (relation of the start of this segment to the base of the styloid process: Above, 425 sides [80%]; below, 2 sides [0.4%]; at same level, 107 sides [20%]; P < 0.0001) (relation of cochlea to ICA: Posterior, 501 sides [85%]; posteromedial, 84 sides [14%]; P < 0.0001); (3) petrous segment (horizontal segment of ICA in the temporal bone) starting at the crossing of the eustachian tube superolateral to the ICA turn in all 10 samples; (4) Gasserian-Clival segment (ascending segment of ICA in the cavernous sinus) starting at the petrolingual ligament (PLL) (relation to vidian canal on imaging: At same level, 360 sides [63%]; below, 154 sides [27%]; above, 53 sides [9%]; P < 0.0001); in this segment, the ICA projected medially toward the clivus in 275 sides (52%) or parallel to the clivus with no deviation in 256 sides (48%; P < 0.0001); (5) sellar segment (medial loop of ICA in the cavernous sinus) starting at the takeoff of the meningeal hypophyseal trunk (ICA was medial into the sella in 271 cases [46%], lateral without touching the sella in 127 cases [23%], and abutting the sella in 182 cases [31%]; P < 0.0001); (6) sphenoid segment (lateral loop of ICA within the cavernous sinus) starting at the crossing of the fourth cranial nerve on the lateral aspect of the cavernous ICA and located directly lateral to the sphenoid sinus; (7) ring segment (ICA between the 2 dural rings) starting at the crossing of the third cranial nerve on the lateral aspect of the ICA; (8) cisternal segment starting at the distal dural ring.Conclusions:The classification may be applied uniformly to all skull base surgical approaches including lateral microsurgical and ventral endoscopic approaches, obviating the need for 2 separate classification systems. The classification allows extrapolation of relevant clinical information because each named segment may indicate potential surgical risk to specific structures.

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Cavernous carotid artery pseudo-aneurysm treated by stenting in acromegalic patient

Cited by 20 publications

References 13 publications

Delayed Cavernous Carotid Artery Pseudoaneurysm Caused by Absorbable Plate Following Transsphenoidal Surgery: Case Report and Review of the Literature

Delayed Cavernous Carotid Artery Pseudoaneurysm Caused by Absorbable Plate Following Transsphenoidal Surgery: Case Report and Review of the Literature

Endovascular management of internal carotid artery injuries secondary to endonasal surgery: case series and review of the literature

Proposed clinical internal carotid artery classification system

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