Giant bilateral cavernous-carotid aneurysms complicated by epistaxis

Epistaxis secondary to a ruptured cavernous-carotid aneurysm that has eroded into the sphenoid sinus is a life-threatening condition. When it is unilateral, balloon or coil embolization of the parent vessel should be considered. When bilateral, coiling the aneurysm to gain hemostasis followed by stent insertion after anticoagulation has been shown to be successful in achieving stabilization of the aneurysm wall whilst maintaining flow through the artery.

We present a case of epistaxis secondary to giant bilateral cavernous-carotid aneurysm. Despite successfully excluding the left-sided aneurysm from the circulation, using coils, recurrent right-sided epistaxis proved extremely difficult to control and ultimately led to the death of our patient.

In recurrent life-threatening episodes of epistaxis resistant to endovascular hemorrhage control, the sphenoid sinus should be packed with bone wax, in order to prevent further episodes of potentially fatal epistaxis, awaiting definitive neuro-radiological intervention.