Department of Radiodiagnosis, (Division of Neuroradiology), 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Neurosurgery, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Neuroradiol J. 2022 Oct;35(5):647-653. doi: 10.1177/19714009221096835. Epub 2022 May 2.
The pseudoaneurysms of the internal carotid artery (ICA) at the skull base form a unique subset of craniofacial pseudoaneurysms with varied diagnostic and therapeutic challenges. Recurrence in a surgically treated pseudoaneurysm may become a nightmare due to very limited number of open and endovascular options.
We report a rare case of recurrent pseudoaneurysm of petrous ICA, which presented with massive epistaxis following an initial successful occlusion by surgical trapping of the parent arterial segment with surgical clip. Cerebral angiography revealed filling of the pseudoaneurysm by small arterial channels from the external carotid, contralateral internal carotid and basilar arterial branches and emptying through the "slipped" distal clip. After a meticulous analysis of the cerebral angiogram, the recurrent pseudoaneurysm was eventually embolized retrogradely through the "slipped" clip after crossing the anterior communicating artery taking a contralateral internal carotid access.
Scrupulous planning and execution of ICA pseudoaneurysms is necessary to prevent recurrence. Naturally occuring collateral routes through the Circle of Willis aid in treatment of "unreachable" vascular lesions.
颅底颈内动脉（ICA）假性动脉瘤是颅面假性动脉瘤的一个独特亚组，具有不同的诊断和治疗挑战。由于开放和血管内治疗选择非常有限，手术治疗的假性动脉瘤复发可能成为一个噩梦。
我们报告了一例罕见的岩骨颈内动脉假性动脉瘤复发病例，该患者在最初通过手术夹闭动脉段成功闭塞后，出现大量鼻出血。脑血管造影显示，假性动脉瘤通过来自颈外动脉、对侧颈内动脉和基底动脉分支的小动脉通道充盈，并通过“滑脱”的远端夹排空。仔细分析脑血管造影后，通过对侧颈内动脉入路穿过前交通动脉，逆行穿过“滑脱”夹，最终对复发性假性动脉瘤进行了栓塞。
为了防止复发，对颈内动脉假性动脉瘤进行仔细的规划和执行是必要的。Willis 环自然形成的侧支循环有助于治疗“无法到达”的血管病变。
