Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Jacksonville, Florida, USA.
Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Jacksonville, Florida, USA.
World Neurosurg. 2020 Jun;138:262-268. doi: 10.1016/j.wneu.2020.02.132. Epub 2020 Mar 3.
Carotid pseudoaneurysm is a rare complication of pituitary surgery and can present with epistaxis. Nasal packing is considered first-line treatment for the control of carotid bleeding. We describe a case of complete occlusion of the contralateral cavernous carotid artery because of nasal packing placed to control hemorrhage from a cavernous carotid pseudoaneurysm.
A 55-year-old man presented with a history of recurrent epistaxis requiring multiple hospital visits and nasal packing over a 9-month period. Nasal endoscopies failed to show a source of bleeding; therefore, the patient underwent bilateral sphenopalatine artery ligations. Postoperative computed tomography angiogram showed no evidence of aneurysm, but did report indistinctness of the lateral sphenoid walls. Symptoms remained controlled for 4 months, but ultimately, he presented to the emergency department with massive epistaxis. A magnetic resonance angiogram noted a 2- to 3-mm left cavernous carotid pseudoaneurysm, and the patient underwent endovascular embolization of bilateral internal maxillary arteries. Significant epistaxis was noted immediately thereafter and he was taken to the operating room to control bleeding. A 4-cm absorbable nasal packing was placed into each sphenoid cavity after profuse bleeding from the left sphenoid sinus was noted. After control of bleeding, cerebral angiogram showed complete occlusion of bilateral internal carotid arteries (ICAs). The right-sided packing was adjusted, and the ICA profusion improved.
To our knowledge, this is the only report that describes complete occlusion of the contralateral cavernous carotid artery because of extrinsic compression of the lateral sphenoid wall, in the setting of a symptomatic pseudoaneurysm.
颈动脉假性动脉瘤是垂体手术后罕见的并发症，可表现为鼻出血。鼻腔填塞被认为是控制颈动脉出血的一线治疗方法。我们描述了一例因鼻腔填塞控制海绵窦颈动脉假性动脉瘤出血而导致对侧海绵窦颈动脉完全闭塞的病例。
一名 55 岁男性，因反复发作的鼻出血需要多次住院和鼻腔填塞，病史长达 9 个月。鼻内窥镜检查未能发现出血源；因此，患者接受了双侧蝶腭动脉结扎术。术后 CT 血管造影显示无动脉瘤证据，但报告蝶骨外侧壁模糊。症状控制了 4 个月，但最终他因大量鼻出血就诊于急诊科。磁共振血管造影显示左侧海绵窦颈动脉有 2-3 毫米的假性动脉瘤，患者接受了双侧上颌内动脉的血管内栓塞。此后立即出现明显的鼻出血，他被送往手术室以控制出血。由于左侧蝶窦大量出血，在每个蝶窦腔内放置了 4 厘米长的可吸收鼻腔填塞。控制出血后，脑血管造影显示双侧颈内动脉完全闭塞。调整右侧填塞物后，颈内动脉充盈改善。
据我们所知，这是唯一一篇描述因外侧蝶骨壁的外部压迫，导致症状性假性动脉瘤时对侧海绵窦颈动脉完全闭塞的报告。
