Emergency balloon occlusion for massive epistaxis due to traumatic carotid-cavernous aneurysm

Case report

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✓ A patient with a giant traumatic aneurysm of the right internal carotid artery presented with recurrent massive epistaxis 30 years after a head injury. During an episode of acute hemorrhage, this patient was effectively treated with occlusion of the internal carotid artery circulation by a detachable inflatable balloon.

Article Information

Address reprint requests to: Richard K. Simpson, Jr., M.D., Ph.D., Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, Texas 77030.

© AANS, except where prohibited by US copyright law.

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Figures

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    Left: Computerized tomography of the head revealing a right parasellar mass in the region of the cavernous sinus. The heavily calcified border and erosion into the sphenoid sinus are indicative of an old lesion. Center and Right: Subtraction arteriograms, anteroposterior (center) and lateral (right) views, showing a giant right cavernous-carotid aneurysm. The fusiform appearance of the aneurysmal sac and its location are consistent with a traumatic origin. Stenosis of the carotid artery immediately proximal to the aneurysm decreased the chance for accidental distal ballon embolization.

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    Magnetic resonance image using blood flowdependent pulse sequences (TR 0.5 msec, TE 35 msec) demonstrating two signal patterns consistent with old and new thrombus but no residual blood flow through the aneurysm.

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