title: Pseudoaneurysm of an aberrant internal carotid artery in the middle ear caused by myringotomy.
abstract: An aberrant internal carotid artery (ICA) is a rare abnormality associated with life-threatening otorrhagia if inadvertently injured during middle-ear surgery including myringotomy. We present a case where a 3-year-old girl experienced massive otorrhagia following myringotomy, and computed tomographic scan showed the aberrant ICA. Bleeding was controlled by ear canal packing, but rebleeding occurred. Investigations by carotid angiography demonstrated a pseudoaneurysm of the aberrant ICA in the middle ear. We attempted surgical repair using a high-flow bypass technique; however, the bypass graft was occluded by embolic complications, and eventually, ligation of the ICA was performed, which led to the paralysis of the patient's left limbs. In this report, management of iatrogenic aberrant ICA injuries and pseudoaneurysms in the middle ear are discussed based on the case that we experienced.
authors.affiliation: Department of Otolaryngology, Sapporo Medical University School of Medicine, S1W16, Chuo-ku, Sapporo 060-8543, Japan. Electronic address: kent@sapmed.ac.jp.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Takano
authors.affiliation: Department of Neurosurgery, Sapporo Medical University School of Medicine, S1W16, Chuo-ku, Sapporo 060-8543, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Wanibuchi
authors.affiliation: Department of Otolaryngology, Sapporo Medical University School of Medicine, S1W16, Chuo-ku, Sapporo 060-8543, Japan.
authors.forename: Fumie
authors.initials: F
authors.lastname: Ito
authors.affiliation: Department of Otolaryngology, Sapporo Medical University School of Medicine, S1W16, Chuo-ku, Sapporo 060-8543, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Himi
mesh_terms: D020212:Carotid Artery Injuries / Q000000981:diagnostic imaging* / Q000209:etiology; D002343:Carotid Artery, Internal / Q000002:abnormalities / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography; D002675:Child, Preschool; D000072226:Computed Tomography Angiography; D005260:Female; D006470:Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D013506:Otologic Surgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D014057:Tomography, X-Ray Computed; D014432:Tympanic Membrane / Q000601:surgery*
keywords: Aberrant internal carotid artery; Myringotomy; Otorrhagia; Pseudoaneurysm