Management of pseudo-aneurysm combined with carotid-cavernous fistula after iatrogenic injury of internal carotid artery due to paranasal sinuses surgery – case report

Although infrequent, occurrences of internal carotid artery (ICA) injuries during transnasal procedures can potentially lead to severe neurological deficits or even prove fatal. We present a case of a 54 years old male patient who suffered an iatrogenic ICA lesion resulting in a pseudo-aneurysm and direct carotid-cavernous fistula after paranasal sinuses surgery. Successful multirdisciplinary treatment included flow diversion, transsphenoidal surgery and embolization of a carotid-cavernous fistula.A sealing of injured ICA wall and complete occlusion of carotid cavernous fistula led to the patient's discharged without any neurological deficits.ICA injury during transnasal surgery is a rare but dangerous and potentially life-threatening complication necessitating multidisciplinary approach and management in a specialized center.