Németh Tamás, Szakács László, Bella Zsolt, Majoros Valéria, Barzó Pál, Vörös Erika
1 Department of Neurosurgery, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary.
2 Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary.
Interv Neuroradiol. 2017 Dec;23(6):609-613. doi: 10.1177/1591019917729804. Epub 2017 Oct 9.
Background We report a case of bilateral malignant otitis externa complicated with bilateral petrous internal carotid artery pseudoaneurysms and their successful treatment with a flow diverter. Case report A 68-year-old woman with serious complications of type II diabetes mellitus had malignant otitis externa on the right side. She was treated with combined antibiotic therapy and underwent mastoidectomy for mastoiditis. She presented at our hospital with acute hemorrhage from the right external auditory canal. The emergency computed tomography (CT) angiography revealed a multiobulated pseudoaneurysm at the petrous segment of the right internal carotid artery. The pseudoaneurysm was treated with a 5 × 40-mm Surpass flow diverter. Three months later, she developed a malignant external otitis on the left side. As the infection progressed, a left-sided mastoiditis, a brain abscess, and a pseudoaneurysm at the petrous segment of the left internal carotid artery developed. The pseudoaneurysm caused bleeding from the left ear, and was treated with a 5 × 50-mm Surpass flow diverter. No recurrent bleeding was observed. Four months later, a follow-up angiography showed complete occlusion of the pseudoaneurysm on the left side, but a residual aneurysm could be detected on the right side. One year after the first intervention, the follow-up CT and magnetic resonance angiography revealed the complete occlusion of the aneurysms bilaterally. Conclusion The use of a flow diverter appears to be an efficient and safe method to occlude carotid pseudoaneurysms even in an inflammatory milieu.
背景 我们报告一例双侧恶性外耳道炎并发双侧岩部颈内动脉假性动脉瘤，并采用血流导向装置成功治疗的病例。病例报告 一名68岁患有II型糖尿病严重并发症的女性右侧患有恶性外耳道炎。她接受了联合抗生素治疗，并因乳突炎接受了乳突切除术。她因右侧外耳道急性出血前来我院就诊。急诊计算机断层扫描（CT）血管造影显示右侧颈内动脉岩段有一个多叶状假性动脉瘤。该假性动脉瘤采用5×40mm的Surpass血流导向装置进行治疗。三个月后，她左侧发生恶性外耳道炎。随着感染进展，左侧出现乳突炎、脑脓肿以及左侧颈内动脉岩段假性动脉瘤。该假性动脉瘤导致左耳出血，采用5×50mm的Surpass血流导向装置进行治疗。未观察到复发出血。四个月后，随访血管造影显示左侧假性动脉瘤完全闭塞，但右侧可检测到残留动脉瘤。首次干预一年后，随访CT和磁共振血管造影显示双侧动脉瘤完全闭塞。结论 即使在炎症环境中，使用血流导向装置似乎也是一种有效且安全的闭塞颈动脉假性动脉瘤的方法。
