Onyx-HD 500 Embolization of a Traumatic Internal Carotid Artery Pseudoaneurysm after Transsphenoidal Surgery.

Abstract

BACKGROUND AND PURPOSE:

Traumatic intracranial pseudoaneurysms present a challenge for treatment. Traditionally these lesions have required a deconstructive approach consisting of vessel sacrifice since their fragile nature often makes direct microsurgical repair or coil embolization hazardous. As a high-viscosity liquid embolic agent that results in immediate, vessel sparing aneurysm occlusion, Onyx-HD 500 represents a uniquely efficacious tool for this clinical situation.

CASE SUMMARY:

We report the case of a 56-year-old right-handed gentleman who suffered a vascular injury to the ICA during revision transsphenoidal surgery for a recurrent pituitary macroadenoma. The patient was initially treated with nasal packing, but after recurrent episodes of epistaxis and a CT angiogram demonstrating a large traumatic ICA pseudoaneurysm, the patient was referred for invasive treatment. Given the presumed fragility of the lesion, embolization with Onyx-HD 500 was chosen in order to safely achieve immediate aneurysm occlusion without the need for vessel sacrifice. After an early recurrence due to incomplete initial embolization, the patient went on to complete occlusion without further hemorrhage.

CONCLUSION:

This case illustrates the utility of a high-viscosity liquid embolic agent in providing immediate protection from rehemorrhage by occluding a large ruptured pseudoaneurysm of the proximal intracranial ICA, while sparing the parent artery.

• Authors: Akshal S Patel, Tristram G Horton, Paul Kalapos, Kevin M Cockroft
• Journal: Journal of neuroimaging : official journal of the American Society of Neuroimaging (J Neuroimaging) 2015 Jul-Aug Vol. 25 Issue 4 Pg. 656-9 ISSN: 1552-6569 [Electronic] United States
• PMID: 25682851 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2015 by the American Society of Neuroimaging.

Chemical References

• Hemostatics
• Onyx HD 500
• Polyvinyls
• Dimethyl Sulfoxide

Topics

• Carotid Artery Injuries (diagnostic imaging, etiology, therapy)
• Dimethyl Sulfoxide (therapeutic use)
• Embolization, Therapeutic (methods)
• Hemostatics (therapeutic use)
• Humans
• Male
• Middle Aged
• Neurosurgical Procedures (adverse effects)
• Polyvinyls (therapeutic use)
• Treatment Outcome