Delayed Carotid Pseudoaneurysms from Iatrogenic Clival Meningeal Branches Avulsion: Recognition and Proposed Management

Abstract Carotid injury during anterior skull base approaches is promptly recognizable and mandates immediate treatment; likewise, development of pseudoaneurysms after such injuries is anticipated and managed. We report here on the delayed development of a pseudoaneurysm as the result of avulsion of...

Full description

Saved in:
Bibliographic Details
Published in:World neurosurgery 2017-08, Vol.104, p.736-744
Main Authors: Almefty, Rami, M.D, Dunn, Ian F., M.D, Aziz-Sultan, Muhammad Ali, M.D, Al-Mefty, Ossama, M.D
Format: Article
Language:English
Subjects:
Aged
Aneurysm, False - diagnostic imaging
Aneurysm, False - therapy
Angiography, Digital Subtraction
Carotid Artery Injuries - diagnostic imaging
Carotid Artery Injuries - therapy
Carotid Artery, Internal - diagnostic imaging
Carotid injury
Carotid occlusion
Cerebral Angiography
Chordoma - surgery
Clivus
Computed Tomography Angiography
Covered stent
Cranial Fossa, Posterior - surgery
Delayed Diagnosis
Dural artery
Female
Humans
Imaging, Three-Dimensional
Magnetic Resonance Angiography
Male
Meningeal Arteries - diagnostic imaging
Meningeal Arteries - injuries
Meningeal Neoplasms - surgery
Meningioma - surgery
Middle Aged
Neurosurgery
Postoperative Complications - diagnostic imaging
Postoperative Complications - therapy
Pseudoaneurysm
Skull base
Stents
Transsphenoidal
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract Carotid injury during anterior skull base approaches is promptly recognizable and mandates immediate treatment; likewise, development of pseudoaneurysms after such injuries is anticipated and managed. We report here on the delayed development of a pseudoaneurysm as the result of avulsion of clival meningeal arteries that manifests as unalarming intraoperative bleeding that appears as brisk and arterial but very easily controlled. Immediate postoperative angiography is negative, necessitating repeated angiography to depict the delayed formation. It is best treated by endovascular means that maintains the patency of the carotid, calling for the development of a suitable device that obliterates the opening of the pseudoaneurysm while maintaining carotid flow that is deployable in the tortuous carotid artery.
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2017.03.016