title: Onyx-HD 500 Embolization of a Traumatic Internal Carotid Artery Pseudoaneurysm after Transsphenoidal Surgery.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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: Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, PA.
authors: Akshal S
authors: AS
authors: Patel
authors: Department of Radiology, Penn State Hershey Medical Center, Hershey, PA.
authors: Tristram G
authors: TG
authors: Horton
authors: Department of Radiology, Penn State Hershey Medical Center, Hershey, PA.
authors: Paul
authors: P
authors: Kalapos
authors: Department of Radiology, Penn State Hershey Medical Center, Hershey, PA.
authors: Kevin M
authors: KM
authors: Cockroft
mesh_terms: D020212:Carotid Artery Injuries / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D004121:Dimethyl Sulfoxide / Q000627:therapeutic use*; D004621:Embolization, Therapeutic / Q000379:methods*; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011145:Polyvinyls / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; C505752:Onyx HD 500; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide
keywords: Neurovascular intervention; epistaxis; liquid embolic; reconstructive