Endovascular Treatment of a Temporal Bone Pseudoaneurysm Presenting as Bloody Otorrhea

Abstract

Objective This case report is designed to illustrate an uncommon presentation of osteoradionecrosis (ORN) of the temporal bone and a treatment method for bloody otorrhea from a pseudoaneurysm of the internal carotid artery (ICA). Design This is a single patient case report Setting University of Missouri-Columbia Hospital and Clinics. Participants The report describes a patient with a history of hypopharyngeal squamous cell carcinoma (SCCA) who was previously treated with chemoradiation therapy and salvage bilateral neck dissections and then presented in a delayed fashion with profuse, episodic bloody otorrhea. Computed tomography (CT) was consistent with ORN of the temporal bone. The patient underwent emergent cerebral angiography. A pseudoaneurysm of the cervicopetrous ICA was confirmed to be the source of the patient's bloody otorrhea. The lesion was treated by endovascular sacrifice of the ICA using the two-catheter coiling technique. Results The patient had no neurologic sequelae or further bleeding after treatment. Conclusions Bloody otorrhea is an uncommon presentation of ORN. Sacrifice of the internal carotid can be considered as a treatment when the source is pseudoaneurysmal.

Cervical–petrous internal carotid artery pseudoaneurysm presenting with otorrhagia treated with endovascular techniques

“…Many of these aneurysms are pseudoaneurysms that arise as a result of trauma,2 9 21 iatrogenic injury,10 15 16 22 23 infection,7 19 radiation,8 11 22 25 or genetic abnormalities, such as fibromuscular dysplasia14 and Ehlers–Danlos syndrome 24. In our case, chronic otitis media is a possible etiology with progressive erosion into the left ICA, although we cannot rule out iatrogenic injury given a history of tympanoplasty.…”

“…CP-ICA aneurysms can present in a variety of different ways, including headache, cranial neuropathies,1 20 23 Horner syndrome,20 transient ischemic attack,4 pulsatile tinnitus,13 hearing loss,6 13 epistaxis,3 4 8 11 13 15 22 and otorrhagia 4 6–8 10 15 19 25. They may also be asymptomatic.…”

“…Traditional surgical clipping of petrous aneurysms has not been greatly utilized due to the difficult location within the petrous bone. Surgical or endovascular ICA occlusion is an option if the patient passes a balloon test occlusion (BTO) or in the setting of life threatening hemorrhage when all other methods have failed 2 25. Surgical bypass has been used in conjunction with surgical or endovascular entrapment 1 6 17 19 22.…”

Petrous Internal Carotid Artery Aneurysm: A Systematic Review

“…In this review, there were 36 cases 6,7,10,16,27,28,30,36,38,39,41,48,51,[53][54][55][56]59,60,63,66,[70][71][72][73][74]78,[80][81][82]85,88 treated with interventional or surgical parent vessel occlusion only without bypass (Table 3).…”

Pseudoaneurysm of the Petrosal Internal Carotid Artery in the Middle Ear as a Complication of Middle Ear Cholesteatoma

“…Surgical clipping is not utilized owing to difficulties with accessibility within the petrous bone. On the other hand, ICA occlusion with a surgical or endovascular technique is a more suitable option in the event of a life-threatening hemorrhage, and when all other methods have failed [ 14 ]. Endovascular techniques include balloon embolization, coil embolization, stand-alone stenting, and stent-assisted coiling [ 1 , 4 , 8 , 10 , 15 ].…”