Internal carotid artery pseudoaneurysm after tonsillectomy treated by endovascular approach. A case report

Abstract

Surgery on the head and neck region may be complicated by vascular trauma, caused by direct injury on the vascular wall. Lesions of the arteries are more dangerous than the venous one. The traumatic lesion may cause laceration of the artery wall, spasm, dissection, arteriovenous fistula, occlusion or pseudoaneurysm. We present a case of a child with a giant ICA pseudoaneurysm after tonsillectomy, manifested by pulsing mass and respiratory distress, which was treated by endovascular approach, occluding the lesion and the proximal artery with Histoacryl. We reinforce that the endovascular approach is the better way to treat most of the traumatic vascular lesions.

Figure 1

Clinical aspect of the right submandibular mass.

Figure 2

CT without contrast showing the right internal carotid artery pseudoaneurysm and the distortion of the normal anatomy.

Figure 3

CT image with contrast showing a large mass occupying the right carotid space, with different densities and compression of the nasopharynx and left deviation of the midline. The lesion extends itself to the masticatory, the posterior cervical and parotid spaces.

Figure 4

Right ICA, AP view: a large pseudoaneurysm of the distal cervical segment of the ICA, with occlusion of this artery after the lesion.

Figure 5

Left vertebral artery angiogram, AP view, showing a large right posterior communicating artery, recanalizing the right ICA and the right middle cerebral artery.

Figure 6

Right ECA angiogram, AP view: recanalization of the ophthalmic and ICA (cavernous segment) through anastomosis with branches of the internal maxillary artery.

Figure 7

X ray, AP view after embolization showing the cast of Histoacryl and Lipiodol into the ICA and the pseudoaneurysm.

Figure 8

Right common carotid artery, AP view after embolization: occlusion of the ICA and recanalization of the ophthalmic and cavernous segment of the ICA.