Introduction: Traumatic intracranial pseudoaneurysms present a challenge for treatment. Their fragile nature often makes coil embolization hazardous. Alternatiely, flow diversion does not result in immediate occlusion and requires long term dual antiplatelet therapy. The liquid embolic agent Onyx-HD 500 represents a unique tool for this clinical situation.
Methods:
We report the case of a traumatic pseudoaneurysm treated to immediate occlusion with Onyx-HD 500. The patient's medical records and imaging studies were reviewed.
Results: This 57 year old male transferred to our institution with epistaxis following revision transsphenoidal pituitary surgery for a pituitary adenoma. Brisk bleeding was noted during the procedure and the nasal passages were aggressively packed. A CT angiogram revealed the presence of 11 x 13 mm saccular aneurysm arising from the intracavernous ICA just proximal to the ophthalmic artery origin. Angiography revealed similar findings and the aneurysm was treated with Onyx-HD 500 liquid embolic agent. Following this, the nasal packings were removed with nasal endoscopy confirming a halt to the bleeding. Patient was discharged in stable condition on an antiplatelet regimen. 7 days later patient returned with epistaxis and was taken back to angiography. A 8mm recurrence was noted and successfully retreated with Onyx-HD 500. 3 months later a follow-up angiogram revealed persistent obliteration of patient's large post-traumatic intracavernous ICA pseudoaneurysm.
Conclusions: This case represents a novel use of Onyx-HD 500. The liquid embolic agent led to immediate aneurysm occlusion along with preservation of the parent vessel
Patient Care: Provide new options to safely treat pseudoaneurysms
Learning Objectives: To highlight a new technique and option for the treatment of traumatic pseudoaneurysms