• World Neurosurg · Aug 2017

    Case Reports

    Delayed Carotid Pseudoaneurysms from Iatrogenic Clival Meningeal Branches Avulsion: Recognition and Proposed Management.

    • Rami Almefty, Ian F Dunn, Muhammad Ali Aziz-Sultan, and Ossama Al-Mefty.
    • Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA. Electronic address: rami.almefty@bnaneuro.net.
    • World Neurosurg. 2017 Aug 1; 104: 736-744.

    BackgroundCarotid injury during anterior skull base approaches is promptly recognizable and mandates immediate treatment; likewise, development of pseudoaneurysms after such injuries is anticipated and managed.MethodsWe report here on the delayed development of a pseudoaneurysm as the result of avulsion of clival meningeal arteries that manifests as unalarming intraoperative bleeding.Results And ConclusionsThe bleeding is brisk and arterial but easily controlled. Immediate postoperative angiography is negative, necessitating repeated angiography to depict the delayed formation. It is best treated by endovascular means that maintains patency of the carotid artery, calling for the development of a suitable device that obliterates the opening of the pseudoaneurysm while maintaining carotid flow that is deployable in the tortuous carotid artery.Copyright © 2017 Elsevier Inc. All rights reserved.

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