Endovascular Particulate and Alcohol Embolization for Near-Fatal Epistaxis from a Skull Base Vascular Malformation

Abstract

A three-year old girl who initially presented at 16 months with epistaxis from an anterior skull base vascular anomaly returned with near-fatal epistaxis despite embolization of the internal maxillary artery at the time of initial presentation. Repeat angiography demonstrated blood supply to the vascular lesion coming from branches of both the external and internal carotid arteries. The patient underwent four sessions of endovascular embolization with polyvinyl alcohol, alcohol, and gelatin microspheres. At the conclusion of treatment, her epistaxis had resolved and the only residual blood supply to the lesions came from bilateral ophthalmic arteries intentionally not sacrificed to prevent loss of vision. Endovascular embolization of both the internal and external carotid arteries is a challenging but important treatment option for life-threatening epistaxis resulting from vascular lesions of the skull base.

Complications of Embolization

“…5,6 The use of coils is not recommended because proximal occlusion may not only induce the development of collateral circulation but also close the door to repeat access in case of recurrence. The cure rate achieved in most reported series is 80% or higher, particularly when the ipsilateral facial artery and contralateral sphenopalatine artery are simultaneously embolized.…”

Complications of Embolization

“…The embolic materials most commonly employed are particles, either of gelatin sponge or polyvinyl alcohol (PVA), and more recently trys-acril gelatin microspheres. 5,6 The use of coils is not recommended because proximal occlusion may not only induce the development of collateral circulation but also close the door to repeat access in case of recurrence. The cure rate achieved in most reported series is 80% or higher, particularly when the ipsilateral facial artery and contralateral sphenopalatine artery are simultaneously embolized.…”