Management of internal carotid artery pseudoaneurysm after radiotherapy to the interior and central skull base

Abstract

Pesudoaneurysm of the internal carotid artery (ICA) is a rare complication after radiotherapy to the skull base. Typical presentation is a sentinel bleeding followed by rupture of the aneurysm causing massive epistaxis. The mortality of rupture pseudoaneurysm of ICA is high, up to 30%. From 2003-2012, 26 patients with pesudoaneurysm of the ICA was managed in our institution. All patients had radiation treatment for nasopharyngeal carcinoma. 70% had 2 courses of radiotherapy and 38% of patients had undergone nasopharyngectomy for recurrent tumour. Mean during of presentation of rupture ICA aneurysm was 101.5 months after completion of radiotherapy. Anterior and posterior nasal packing was the first line management and was successful in temporary heamostasis in 17 patients. Airway protection in terms of intubation or surgical airway was performed in 17 patients, with 7 patients failed immediate airway protection. Endovascular treatment was the first line intervention in 23 patients and in 20 patients it was successful. Remaining 3 patients had extracranial-intracranial bypass. 8 patients (31%) died from failed control of bleeding or complications of treatment. Univariate analysis showed successful temporary haemostasis and successful airway control are predictors of survival.