title: Ruptured Aneurysm of an Aberrant Internal Carotid Artery Successfully Treated with Simultaneous Intervention and Surgery in a Hybrid Operating Room.
abstract: BACKGROUND
  Aberrant internal carotid artery (aICA) is an anatomic anomaly whereby the internal carotid artery courses through the tympanic cavity without separation by bone. Because aICA is rare, there are no definite treatment strategies for aICA and its complications.
  
  
  METHODS
  We report a case of aICA accompanied by pseudoaneurysm formation and massive bleeding. The patient was a 31-year-old woman with a 2-year history of hearing loss, ear fullness, and pulsatile tinnitus in her left ear. After a diagnosis of otitis media with effusion, she underwent a myringotomy and massive arterial bleeding occurred. After the bleeding was temporarily stopped, aICA and pseudoaneurysm formation on the aICA were shown. To prevent rebleeding, we performed endovascular internal trapping around the pseudoaneurysm after performing common carotid artery to radial artery to middle cerebral artery bypass grafting. After surgery, the aneurysm disappeared. In addition, no new neurologic complications were observed, and the patient's hearing improved and the tinnitus diminished.
  
  
  CONCLUSIONS
  This is the first case report of an aICA complicated by pseudoaneurysm formation successfully treated with simultaneous endovascular trapping and high-flow bypass in a hybrid operating room.
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Kawamura
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Sayama
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Maehara
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Ataru
authors.initials: A
authors.lastname: Nishimura
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. Electronic address: kiihara@ns.med.kyushu-u.ac.jp.
authors.forename: Koji
authors.initials: K
authors.lastname: Iihara
mesh_terms: D000328:Adult; D017541:Aneurysm, False / Q000601:surgery*; D017542:Aneurysm, Ruptured / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000601:surgery*; D002533:Cerebral Angiography; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000601:surgery; D009873:Operating Rooms; D011183:Postoperative Complications / Q000209:etiology; D014012:Tinnitus / Q000209:etiology / Q000601:surgery
keywords: Aberrant internal carotid artery; Bypass grafting; Endovascular internal trapping; Hybrid operating room; Myringotomy; Pseudoaneurysm