Intracranial Internal Carotid Artery Pseudoaneurysm: A Narrative Review and Update for Otolaryngology Residents

Massive epistaxis due to rupture of Intracranial Internal carotid artery (ICA) pseudoaneurysm is rarely encountered in Otolaryngology emergency but when it does, it requires immediate action. To provide an update on the approach toward diagnosis and management of patients with ruptured intracranial ICA pseudoaneurysm from an otolaryngologist perspective. The PubMed library was searched for previously published reviews, systematic reviews, or meta-analyses for intracranial ICA pseudoaneurysm, and a narrative review was formulated with a focus on Otolaryngology practice. Nasal bleeds that are massive and have a history of preceding sino-nasal surgical intervention, head trauma, sinonasal infection, or head-neck radiation must raise suspicion for bleeding from ICA. The classic triad of unilateral blindness, orbital fractures/head injury, and massive epistaxis is almost pathognomonic for ICA pseudoaneurysm. Digital subtraction angiography remains the gold standard for the diagnosis. Endovascular interventions such as stenting and/or coiling remain the standard of care for such patients. However, if advanced interventional neuro-radiology units are not available immediately, an otolaryngologist must take action to stabilize the patient, order investigations timely, and control the bleeding. Rupture of ICA pseudoaneurysm requires the collaboration of the Emergency team, Otolaryngologists, Interventional Neuro-radiologists, Neurosurgeons, Anaesthetists, and Vascular surgeons to ensure timely management of such patients. The stepwise approach in this review can act as a guide for managing such cases.