title: Endovascular particulate and alcohol embolization for near-fatal epistaxis from a skull base vascular malformation.
abstract: A three-year old girl who initially presented at 16 months with epistaxis from an anterior skull base vascular anomaly returned with near-fatal epistaxis despite embolization of the internal maxillary artery at the time of initial presentation. Repeat angiography demonstrated blood supply to the vascular lesion coming from branches of both the external and internal carotid arteries. The patient underwent four sessions of endovascular embolization with polyvinyl alcohol, alcohol, and gelatin microspheres. At the conclusion of treatment, her epistaxis had resolved and the only residual blood supply to the lesions came from bilateral ophthalmic arteries intentionally not sacrificed to prevent loss of vision. Endovascular embolization of both the internal and external carotid arteries is a challenging but important treatment option for life-threatening epistaxis resulting from vascular lesions of the skull base.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15218, USA.
authors.forename: C J
authors.initials: CJ
authors.lastname: Koebbe
authors.forename: M
authors.initials: M
authors.lastname: Horowitz
authors.forename: E I
authors.initials: EI
authors.lastname: Levy
authors.forename: D
authors.initials: D
authors.lastname: Adelson
authors.forename: C
authors.initials: C
authors.lastname: Jungries
mesh_terms: D002342:Carotid Artery, External / Q000002:abnormalities / Q000000981:diagnostic imaging; D002343:Carotid Artery, Internal / Q000002:abnormalities / Q000000981:diagnostic imaging; D004621:Embolization, Therapeutic; D004844:Epistaxis / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007223:Infant; D002538:Intracranial Arteriovenous Malformations / Q000628:therapy*; D008438:Maxillary Artery / Q000002:abnormalities / Q000000981:diagnostic imaging; D011142:Polyvinyl Alcohol; D011859:Radiography; D012008:Recurrence; D019233:Retreatment; D019291:Skull Base / Q000098:blood supply* / Q000000981:diagnostic imaging
chemical_list: D011142:Polyvinyl Alcohol