Images in Neurosurgery

A. Coronal view, CTA reconstruction

B. Sagittal view, CTA reconstruction

C. Lateral view, angiogram

D. Lateral view, angiogram following aneurysm treatment

Massive Epistaxis from Cavernous ICA Aneurysm Invading the Sphenoid Sinus

These images demonstrate an aneurysm arising from the cavernous segment of the left internal carotid artery, which has eroded through the sphenoid sinus anterior-inferiorly with a distal daughter sac. This lesion was discovered following multiple episodes of massive epistaxis resulting in airway obstruction from blood clots and hypovolemic shock. The epistaxis was initially managed with nasal packing and embolization of the sphenopalatine arteries with only temporary success. Epistaxis from a true ICA aneurysm is very rare and unlike this case, is usually associated with traumatic injuries, radiation, or infection. The aneurysm was finally treated with placement of a flow diverter and adjuvant coil embolization.

Submitted by:
Leonardo B. C. Brasiliense, MD
Division of Neurosurgery, University of Arizona, Tucson, Arizona

Ricardo A. Hanel, MD, PhD
Baptist Neurological Institute, Lyerly Neurosurgery, Jacksonville, Florida