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Giant petrous internal carotid aneurysm causing epistaxis: A case report
Tomoaki Tamada1, Takeshi Mikami1, Yukinori Akiyama1
1Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan.
Summary
Giant petrous internal carotid artery (ICA) aneurysms are rare but can cause severe epistaxis if ruptured. This case highlights successful surgical trapping and bypass for a giant petrous ICA aneurysm presenting with epistaxis.
Area of Science:
- Vascular Surgery
- Neurosurgery
- Cranial Nerve Surgery
Background:
- Aneurysms of the petrous portion of the internal carotid artery (ICA) are exceptionally rare.
- They often present asymptomatically or with cranial nerve palsy due to mass effect.
- Rupture can lead to life-threatening hemorrhage, particularly massive epistaxis.
Observation:
- A 73-year-old male presented with epistaxis caused by a giant petrous ICA aneurysm.
- No history of trauma or coagulopathy was reported.
- Computed tomography angiography revealed the aneurysm eroding the temporal bone.
Findings:
- The giant petrous carotid aneurysm was successfully treated with aneurysm trapping and high-flow bypass using a radial artery.
- Anatomical factors, such as a thin bony partition between the ICA and sphenoid sinus, may predispose to rupture.
- Petrous carotid aneurysms, though typically asymptomatic, can manifest as severe epistaxis upon rupture.
Implications:
- This case demonstrates a viable surgical strategy for managing giant petrous ICA aneurysms.
- Understanding the anatomical vulnerabilities is crucial for predicting and preventing rupture.
- Early diagnosis and intervention are vital for patients presenting with epistaxis due to petrous ICA aneurysms.
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