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Few reports have been made on the presentation and treatment of schwannomas originating in the sphenoid sinus due to their rarity. We report the case of a 60-year-old woman who presented with a cyst-like mass in the right sphenoid sinus on magnetic resonance imaging. Computed tomography showed a bone defect in the internal carotid artery (ICA) and enlargement of the round foramen on the affected side. A histopathological diagnosis of schwannoma was made, and endoscopic sinus surgery was performed. The anterior part of the tumor could be easily removed by aspiration; however, its adhesion to the ICA was remarkable, and its boundaries were unclear. Although partial paralysis of the maxillary nerve remained, no recurrence occurred for over 10 years. Careful evaluation should be performed to check for bone defects in the nerve to differentially diagnose schwannoma from cystic masses of the sphenoid sinus. Additionally, excision of masses similar to the presented case may expectedly be difficult because of unclear excisional margins and strong capsule adherence to important organs such as the ICA. Moreover, correct imaging, histopathological diagnosis, and appropriate informed consent are essential before surgery.

In Eagle syndrome, elongated styloid processes may provoke internal carotid dissection and pseudoaneurysm causing stroke and data regarding possible complications or long-term results of pseudoaneurysm treatment using a flow diverter are limited. We report a case of a dissection-related pseudoaneurysm in the left cervical carotid artery treated by implantation of a flow diverter. Follow-up imaging of the flow diverter showed fracture of a continuous radiopaque marker at 3 months and fracture of a second continuous radiopaque marker at 7 months, while contrasting of the vessel was preserved. At the time of angiographic control (8 months after implantation), the flow diverter and the extracranial left internal carotid artery were occluded, and the patient did not experience any symptoms throughout the period.

Common carotid artery (CCA) rupture during parathyroid cancer surgery is extremely rare and is generally life-threatening. We present a case of successful management of a ruptured CCA following the emergency placement of stent-graft in a 59-year-old male diagnosed with recurrent parathyroid cancer. During recurrent parathyroid cancer surgery, his right CCA ruptured unexpectedly, and his vital signs deteriorated rapidly despite surgical management. After stent replacement, his unstable vital signs improved and, thereafter, he was discharged without any complications.

Craniopharyngiomas are benign tumors of the sellar and parasellar region for which surgical resection remains the treatment of choice. There are many publications on the most frequent postoperative complications, but few reports on subclinical lesions affecting the arteries of the circle of Willis, despite their high morbidity and mortality rate. Trauma-induced aneurysms are infrequent, representing less than 1% of intracranial aneurysms. Iatrogenic intracranial pseudoaneurysms are a subtype of surgically induced aneurysms developed as a result of direct injury to the arterial wall or after dissection of tumors adherent to the vessel adventitia. The natural history of these lesions is not well known because their incidence is extremely low. We report two cases of postoperative aneurysms of the internal carotid artery after craniopharyngioma resection and a brief review on the management of such lesions.

Background Pseudoaneurysms of the carotid artery are rare and can be both a cause and consequence of carotid blowout syndrome (CBS) in patients with head and neck cancer. Surgical or endovascular treatment approaches may be useful for managing this condition. Case Report A 55-year-old man presented with a pulsatile mass surrounding the carotid bifurcation in the neck. He reported a history of CBS that occurred as a surgical complication while removing a benign neck cyst. Additionally, he reported a history of laryngeal cancer that underwent complete remission after surgery and radiotherapy. The mass was diagnosed as a pseudoaneurysm. Surgical treatment proved challenging owing to the patient’s history of neck surgery and radiotherapy; therefore, stent-graft deployment was performed and the absence of pulsations was checked through the neck mass. Conclusion Endovascular treatment may be a useful therapeutic strategy in cases of post-CBS pseudoaneurysm in patients undergoing surgery and/or radiotherapy for head and neck cancer.

Carotid blowout syndrome (CBS) is a fatal complication of head and neck cancer. Endovascular treatment, particularly deconstructive embolization, is effective for CBS, but it might result in thromboembolic events. We report the case of a 57-year-old man with underlying recurrent head and neck cancer who had CBS. The patient received endovascular embolization of the right internal, external, and common carotid arteries. Right internal carotid artery to middle cerebral artery embolic occlusion was noted immediately after the procedure, and left-sided weakness and facial palsy were found. Ipsilateral suprabulbar cervical internal carotid artery puncture was performed under fluoroscopic guidance, and rescue suction thrombectomy was successful. The patient had no significant neurological sequela. Transcarotid intraarterial thrombectomy is a reasonable method for managing postembolization large vessel occlusion, even in the neck, after irradiation.

Carotid Blow-Out Syndrome (CBS) is a life-threatening complication of head and neck cancer. We report the case of a patient who suffered a fatal haemorrhage whilst driving, review the law and role of healthcare professionals in preventing such events.

An iatrogenic internal carotid artery (ICA) pseudoaneurysm is an extremely rare complication of cervical spine surgery. Here we report an extraordinary case of massive hematemesis due to a ruptured ICA pseudoaneurysm caused by the laminoplasty plate 10 years after cervical spine surgery. Computed tomography angiography revealed a ruptured 4×10-mm left extracranial ICA pseudoaneurysm probably connected to the pharynx. Emergent surgery was performed because of the uncontrolled massive bleeding. After complete resection of the injured segment, an interposition graft with a 6-mm polytetrafluoroethylene graft was placed and the fistula tract to the pharynx was repaired.

Aim: Carotid blowout syndrome is a rare but devastating complication of head and neck malignancy, and is associated with a reported mortality and neurologic morbidity of 40% and 60% respectively. The aim of this case report is to present our experience with a single case of massive haemorrhage from the internal carotid artery (ICA) in a previously irradiated neck treated with a stentgraft, hence maintaining carotid artery patency. Methods: Relevant medical data were collected and literature review was performed. Results: The patient is a 61-year-old male with a previous history of head and neck cancer submitted to radical surgery and chemo and radiotherapy. Seven years later, the patient was diagnosed with osteoradionecrosis of the mandibula and submitted to surgery. Hospital stay was prolonged due to local infection and suture dehiscence with carotid artery exposure. No previous episodes of sentinel bleeding were registered. Life-threatening haemorrhage from the surgical wound started acutely. Under manual compression, the patient was rushed to the angiography suite and the diagnostic angiography ascertained active bleeding from the ICA. A stentgraft Atrium Advanta V12 (Maquet Getinge group, Hudson, NH, USA) was deployed maintaining ICA patency. The patient was subsequently submitted to surgical reconstruction and had an uneventful recovery. Discussion: Management of acute carotid blow syndrome is critical, often requiring a multidisciplinary approach. Stentgraft placement is a highly feasible and effective approach with lower morbimortality rates when compared to surgical repair/ ligation or endovascular embolization. However long term results with patency rates are currently lacking.

A retrospective analysis was made on 5 cases who had the traumatic carotid artery injury with massive epistaxis (from September 2007 to June 2011). All of them were finally diagnosed by digital substraction angiography (DSA). Among them, 2 cases of traumatic pesudoaneurysm from internal maxillary artery were embolized with polyvinyl alcohol particles and gelatin sponge. One case was carotid-cavernous fistula (CCF) with traumatic pesudoaneurysm located in the sphenoid sinus. This patient's internal carotid artery (ICA) and fistula was blocked with balloon, and then ICA was clipped proximal to the posterior communicating artery. One case with injuried ICA was treated with blocking by balloon. The pesudoaneurysm located in ICA cavernous segment of one case was embolized with coil and liquid glue. No recurrence was found after successful surgeries. Patients with massive epistaxis or recurrent epistaxis after craniofacial trauma should undergo CT angiography (CTA) or DSA examination so as to get proper diagnosis and treatment as early as possible.

Introduction: The treatment of lesions which compromise the cavernous sinus has always constituted a challenge. The endovascular treatment of these lesions has presented diverse alterations over the last years. This study aims to evaluate the endovascular treatment of vascular lesions in the internal carotid artery (ICA), cavernous segment, performed at our service. Method: This is a descriptive study, retrospective and prospective. Patients with aneurysm in the cavernous ICA or direct carotid-cavernous fistula (dCCF) submitted to endovascular treatment were evaluated. Results: Included were 26 patients with intracavernous aneurysms and 10 with dCCF. All aneurysms were treated with ICA occlusion. The dCCF were treated with occlusion of the ICA in seven cases and with selective fistula occlusion in the remaining three. There was an improvement in pain and ocular proptosis in all patients with dCCF. In the patients with intracavernous aneurysms, the incidence of retroorbitary pain went from 84.6% to a mere 30.8%, following the treatment. Following endovascular treatment, there was an important improvement in the dysfunction of cranial nerves, compromised in both patient groups, mainly in the oculomotor nerve. Conclusion: The endovascular treatment provided an improvement in the patients of this study, especially in the criteria pain and oculomotor nerve dysfunction.

ABSTRACT Objective: to evaluate the endovascular treatment of vascular lesions of the cavernous segment of the internal carotidartery (ICA) performed at our institution. Methods: we conducted a descriptive, retrospective and prospective study of patients with aneurysms of the cavernous portion of the ICA or with direct carotid-cavernous fistulas (dCCF) undergoing endovascular treatment. Results: we included 26 patients with intracavernous aneurysms and ten with dCCF. All aneurysms were treated with ICA occlusion. Those with dCCF were treated with occlusion in seven cases and with selective fistula occlusion in the remaining three. There was improvement of pain and ocular proptosis in all patients with dCCF. In patients with intracavernous aneurysms, the incidence of retro-orbital pain fell from 84.6% to 30.8% after treatment. The endovascular treatment decreased the dysfunction of affected cranial nerves in both groups, especially the oculomotor one. Conclusion: the endovascular treatment significantly improved the symptoms in the patients studied, especially those related to pain and oculomotor nerve dysfunction.