Park Jung-Soo, Jang Hyoung Gyu
Department of Neurosurgery, Jeonbuk National University Medical School and Hospital, Jeonju 54907, South Korea.
World J Clin Cases. 2022 Sep 6;10(25):9121-9126. doi: 10.12998/wjcc.v10.i25.9121.
Radiation therapy (RT) for nasopharyngeal cancer can cause several complications. In rare cases, an internal carotid artery pseudoaneurysm can occur, which can be fatal. We report the experience of a nasopharyngeal cancer patient who underwent radiation therapy and subsequently developed a fatal pseudoaneurysm of the petrous internal carotid artery.
A 39-year-old man was diagnosed with nasopharyngeal cancer 2 years ago (American Joint Committee on Cancer Stage T3N2M0) and received concurrent chemoradiation therapy. He subsequently relapsed and received chemotherapy. One week after the 4th cycle of chemotherapy, he was admitted to the emergency room of our hospital because of massive epistaxis accompanied by a headache. A pseudoaneurysm of the petrous internal carotid artery was confirmed by digital subtraction angiography (DSA). Stent-assisted endovascular coil embolization was performed and complete occlusion was achieved. No pseudoaneurysm was observed on DSA after coil embolization; however, intermittent epistaxis was maintained even after coil embolization. After seven days, a diagnostic laryngoscopy was performed. Massive bleeding occurred after aspiration of the blood clot during the laryngoscopy and the patient died of hypovolemic shock. In this case, epistaxis may have been a sign of pseudoaneurysm; therefore, treatment such as embolization should be performed promptly, and careful management should be undertaken after treatment.
This case highlights a rare, serious complication of RT in nasopharyngeal cancer and how it should be recognized and treated.
鼻咽癌的放射治疗（RT）可导致多种并发症。在罕见情况下，可发生颈内动脉假性动脉瘤，这可能是致命的。我们报告了一名鼻咽癌患者的经历，该患者接受放射治疗后发生了岩骨段颈内动脉致命性假性动脉瘤。
一名39岁男性2年前被诊断为鼻咽癌（美国癌症联合委员会分期T3N2M0），接受了同步放化疗。随后他复发并接受了化疗。在第4周期化疗后一周，他因大量鼻出血伴头痛入住我院急诊室。数字减影血管造影（DSA）证实为岩骨段颈内动脉假性动脉瘤。进行了支架辅助血管内弹簧圈栓塞术并实现了完全闭塞。弹簧圈栓塞术后DSA未观察到假性动脉瘤；然而，即使在弹簧圈栓塞术后仍有间歇性鼻出血。7天后，进行了诊断性喉镜检查。喉镜检查时在吸出血凝块后发生大量出血，患者死于低血容量性休克。在本病例中，鼻出血可能是假性动脉瘤的一个征象；因此，应及时进行栓塞等治疗，治疗后应进行仔细管理。
本病例突出了鼻咽癌放射治疗一种罕见的严重并发症以及应如何识别和治疗。
