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Clinical characteristics of internal carotid artery pseudoaneurysms in the sphenoid sinus
Di Deng1, Jintao Du1, Feng Liu1
1Department of Otorhinolaryngology Head & Neck surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China.
Insights
Sphenoid sinus internal carotid artery (ICA) pseudoaneurysms are rare but dangerous. Accurate diagnosis using MRI and DSA, followed by prompt intervention, is crucial for successful management and preventing severe outcomes like vision loss.
Area of Science:
- Vascular Surgery
- Neurosurgery
- Otolaryngology
Background:
- Internal carotid artery (ICA) pseudoaneurysms in the sphenoid sinus present diagnostic challenges, often leading to misdiagnosis due to symptoms like epistaxis mimicking common ENT conditions.
- Delayed or improper management of these pseudoaneurysms carries a high mortality risk.
Purpose of the Study:
- To investigate the clinical characteristics, diagnostic modalities, and treatment outcomes of internal carotid artery pseudoaneurysms located in the sphenoid sinus.
Main Methods:
- Retrospective analysis of clinical data from 8 patients diagnosed with sphenoid sinus ICA pseudoaneurysms between 2008 and 2017.
- Evaluation of clinical features, imaging results (CT, MRI, DSA), and treatment strategies including coated stent intervention and carotid artery ligation.
Main Results:
- Six of eight patients presented with recurrent epistaxis; two experienced vision loss. Head trauma was a predisposing factor in 5/8 patients.
- CT scans frequently led to misdiagnosis, while MRI and digital subtraction angiography (DSA) proved essential for accurate diagnosis.
- Interventional treatment (coated stent) was successful in most cases, with carotid artery ligation used in emergencies. One case of intervention failure was resolved by ligation, and one patient regained vision.
Conclusions:
- Accurate diagnosis of sphenoid sinus ICA pseudoaneurysms requires close collaboration between otolaryngologists and imaging specialists.
- Both interventional and surgical treatments can yield favorable outcomes, emphasizing the need for multidisciplinary cooperation between ENT, neurosurgery, and interventional departments.
- Prompt and accurate diagnosis coupled with timely, appropriate treatment are paramount for managing these rare but critical vascular lesions.
Background:
Internal carotid artery (ICA) pseudoaneurysms are associated with high mortality if lack of proper management. Patients with ICA pseudoaneurysms in the sphenoid sinus often visit a hospital's ear, nose and throat (ENT) department due to nasal bleeding. In such cases, simple examination and therapy will lead to misdiagnosis.
Objective:
This study sought to investigate the clinical characteristics, diagnostic methods and treatment of ICA pseudoaneurysms in the sphenoid sinus.
Methods:
Various data, including clinical features, imaging examination results, and treatment and prognosis information, were collected and analyzed for 8 patients who visited the Department of Otolaryngology, Head & Neck Surgery of West China Hospital from March 2008 to January 2017.
Results:
The patients included 6 males and 2 females (ages 16 to 56 years). Repeated epistaxis was a common symptom in six of the eight patients (6/8), whereas monocular blindness and binocular blindness were observed in the other two patients. Head trauma was found to play a role in the induction of ICA pseudoaneurysms, given that five patients (5/8) exhibited a specific history of head injury. CT examination tended to result in misdiagnosis, whereas MRI and digital subtraction angiography (DSA) were helpful for obtaining a definite diagnosis with all diagnoses were confirmed via DSA. Coated stent intervention was performed in five patients, while carotid artery ligation was performed in two patients in emergency situations: one of whom exhibited paraplegia, but recovery was ultimately observed after rehabilitation. Moreover, failure of coated stent intervention in one patient was resolved via additional unilateral common carotid artery ligation. Furthermore, one patient with vision loss experienced vision restoration. One patient discontinued treatment for personal reasons and was lost to follow-up. No recurrence was observed in the other 7 patients.
Conclusion:
ICA pseudoaneurysms in the sphenoid sinus are uncommon. To accurately identify ICA pseudoaneurysms, collaboration between otolaryngologists and imaging specialists is essential. On the other hand, both surgical and interventional treatments can achieve good results; therefore, otolaryngologists should enhance their cooperation with neurosurgery and intervention departments. Accurate diagnosis and rapid treatment are keys to managing ICA pseudoaneurysms.
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