Stent Coil Embolization of an Iatrogenic Cavernous Carotid Pseudoaneurysm

Background: Absorbable plates have recently become more frequently used in the repair of skull base cranial defects following endonasal operations. Traumatic intracranial pseudoaneurysms have been reported secondary to placement of these plates, often requiring endovascular intervention. Previous treatment of these pseudoaneurysms has been deconstructive with endovascular versus open carotid sacrifice.

Objective: The purpose of this study is to report a cavernous internal carotid artery injury from a migrating absorbable plate used to reconstruct the sellar floor, as well as successful endovascular reconstruction with stent coil embolization of the pseudoaneurysm. No short-term hemorrhagic or embolic events were observed.

Methods: A 57-year-old man with a large nonfunctional pituitary macroadenoma underwent a gross total endoscopic transsphenoidal resection of the adenoma. Following resection, an absorbable plate was placed extradurally to reconstruct the sellar floor.

Results: The patient was discharged home on postoperative day 2 in excellent condition. However 6 weeks later, he experienced repeated epistaxis, followed by delayed dysarthria as well as left-hand and facial weakness. Neuroimaging revealed subacute infarcts in right middle cerebral artery distribution. CT angiogram revealed a 6 × 4 mm pseudoaneurysm located on the medial wall of the cavernous internal carotid artery. Stent coiling with placement of eight detachable coils was used to successfully obliterate the pseudoaneurysm, and the patient regained full recovery of his strength.

Conclusion: Although rare, migration of a reconstructing plate of the sellar floor may account for a subacute presentation of epistaxis or embolic stroke. In addition, short segment embolization with stent coil is an excellent option for the treatment of iatrogenic carotid pseudoaneurysms following endonasal skull base operations.