title: Traumatic intra-sphenoidal pseudoaneurysm lodged inside the fractured sphenoidal sinus.
abstract: We describe a case of traumatic intra-sphenoidal right internal carotid artery pseudoaneurysm lodged inside the fractured sphenoidal sinus that developed in a patient with a previous history of frontal and skull base fractures involving the sphenoid sinus and walls of the carotid canal, but with normal intracranial findings at early CT angiography. The patient presented two episodes of massive life-threatening delayed epistaxis before successful endovascular treatment combining the use of coils and an uncovered stent was instituted. This case report highlights that patients with head trauma who present sphenoid sinus fractures with or without massive epistaxis should be evaluated for the development of traumatic internal carotid artery pseudoaneurysm as soon as possible. If the first angiographic evaluation reveals normal findings, repeated epistaxis should prompt a second angiographic evaluation because psudoaneurysm takes time to develop. Early treatment with uncovered stent of the aneurysm can be a life-saving therapeutic approach.
authors.affiliation: Department of Head and Neck Surgery, CHU, Montpellier, France;|Department of Maxillo-Facial Surgery, University of Rome La Sapienza, Rome, Italy;
authors.forename: P
authors.initials: P
authors.lastname: Pelliccia
authors.affiliation: Department of Head and Neck Surgery, CHU, Montpellier, France;
authors.forename: M
authors.initials: M
authors.lastname: Bartolomeo
authors.affiliation: Department of Maxillo-Facial Surgery, University of Rome La Sapienza, Rome, Italy;
authors.forename: G
authors.initials: G
authors.lastname: Iannetti
authors.affiliation: Department of Neuroradiology, CHU, Montpellier, France.
authors.forename: A
authors.initials: A
authors.lastname: Bonafé
authors.affiliation: Department of Head and Neck Surgery, CHU, Montpellier, France;
authors.forename: M
authors.initials: M
authors.lastname: Makeieff
mesh_terms: D017541:Aneurysm, False / Q000209:etiology*; D002340:Carotid Artery Diseases / Q000209:etiology*; D002343:Carotid Artery, Internal; D006801:Humans; D008297:Male; D012887:Skull Fractures / Q000150:complications*; D013101:Sphenoid Sinus / Q000293:injuries*; D055815:Young Adult
keywords: Delayed epistaxis; Endovascular procedures; Epistaxis; Head injuries; Pseudoaneurysm; Sphenoidal sinus fracture