J Neurol Surg Rep 2013; 74(01): 010-016
DOI: 10.1055/s-0033-1338164
Georg Thieme Verlag KG Stuttgart · New York

Delayed Cavernous Carotid Artery Pseudoaneurysm Caused by Absorbable Plate Following Transsphenoidal Surgery: Case Report and Review of the Literature

Alexander Tuchman
1   Department of Neurosurgery, University of Southern California, Los Angeles, California, USA
,
Alexander A. Khalessi
1   Department of Neurosurgery, University of Southern California, Los Angeles, California, USA
,
Frank J. Attenello
1   Department of Neurosurgery, University of Southern California, Los Angeles, California, USA
,
Arun P. Amar
1   Department of Neurosurgery, University of Southern California, Los Angeles, California, USA
,
Gabriel Zada
1   Department of Neurosurgery, University of Southern California, Los Angeles, California, USA
› Author Affiliations
Further Information

Publication History

31 May 2012

24 August 2012

Publication Date:
08 April 2013 (online)

Abstract

Background Bioabsorbable plates are frequently utilized in the repair of skull base defects following transsphenoidal operations. Traumatic intracranial pseudoaneurysms are a rare complication of transsphenoidal surgery. To date, iatrogenic carotid pseudoaneurysm associated with the use of an absorbable plate has been reported once.

Results A 57-year-old man with a large nonfunctional pituitary macroadenoma underwent an endoscopic transsphenoidal operation with gross total resection. An absorbable plate was placed extradurally to reconstruct the sellar floor. He experienced delayed repeated epistaxis, followed by a right middle cerebral artery distribution embolic stroke. Computed tomorgraphy (CT) angiogram 6 weeks postoperatively revealed a 6 × 4 mm pseudoaneurysm located on the medial wall of the right cavernous internal carotid artery. Stent coiling was used to successfully obliterate the pseudoaneurysm, and the patient fully recovered.

Conclusion Delayed erosion of the carotid artery wall caused by a plate used to reconstruct the sellar floor may manifest with epistaxis or embolic stroke. The authors' preference is to avoid insertion of a rigid plate for sellar floor reconstruction in the absence of intraoperative cerebrospinal fluid (CSF) leaks, unless it is required to buttress a large skull base defect. Short-segment embolization with stent coiling is the preferred treatment option for carotid pseudoaneurysms following transsphenoidal operations.