Carotid

Case report: Inadvertent carotid artery injury during myringotomy as a result of carotid artery dehiscence

July 21, 2013     Christopher Schutt, MD; Sharmila Dissanaike, MD; John Marchbanks, MD
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Abstract

We report the case of a 3-year-old girl whose internal carotid artery was pierced during a myringotomy. Postoperative computed tomography demonstrated that the complication was caused by a dehiscent carotid canal wall; contralateral dehiscence was also present. The patient had previously received two sets of middle ear ventilation tubes with no complications. This article addresses the epidemiology and anatomy of carotid dehiscence, and discusses methods to potentially prevent this complication, including screening and imaging modalities.

Management of head and neck paragangliomas: A series of 9 cases and review of the literature

August 10, 2012     Domenico Destito, MD; Sebastiano Bucolo, MD; Alessandra Florio, MD; Carmelo Quattrocchi, MD
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Abstract

We conducted a retrospective study of the long-term functional results of surgery for head and neck paragangliomas. Our study population was made up of 9 patients—4 men and 5 women, aged 22 to 59 years (mean: 46.6; median: 51)—who had undergone surgical excision of a head and neck paraganglioma from January 2002 through December 2006 in the ENT Department at Pugliese-Ciaccio Hospital in Catanzaro, Italy. Of the 9 paragangliomas, 4 were carotid body tumors, 2 were glomus tympanicum tumors, and 3 were glomus vagale tumors. None of the cases was bilateral or hereditary. Complete tumor resection was achieved in 8 patients; in the remaining patient, a small amount of intradural residual vagus nerve paraganglioma had to be left in situ. The internal carotid artery was preserved in all 4 resections of carotid body tumors. There was only 1 case of postoperative lower cranial nerve deficits, which occurred in a patient with a carotid body tumor. Follow-up ranged from 12 to 53 months (mean: 37.2; median: 36), and no recurrences were documented. Our small sample showed that surgical treatment of head and neck paragangliomas provided excellent tumor control with low postoperative morbidity, even in patients with large tumors. A wait-and-scan policy may be more appropriate for patients at an advanced age or who are otherwise at high surgical risk, as well as for those whose tumors have recurred following radiotherapy.

Carotid pseudoaneurysm of the neck

November 22, 2011     Edward C.F. Lam, MS4, Enrique Palacios, MD, FACR, and Harold Neitzschman, MD, FACR, FACNM, FAAP
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Unilateral macroglossia as sole presenting manifestation of internal carotid artery dissection

September 20, 2011     Joerg-Patrick Stübgen, MD
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Abstract

A patient presented with acute-onset, painless, unilateral enlargement of the tongue. Steroid treatment for angio-edema was ineffective, and a biopsy of an apparent mass of the tongue base showed normal tissue. Subsequent magnetic resonance imaging showed enlargement, enhancement, asymmetric T2 hyperintensity of the left half of the tongue, and dissection of the left cervical internal carotid artery (ICA) at the skull base. Unilateral enlargement of the tongue due to acute neurogenic denervation may be the sole clinical presentation of a spontaneous arterial dissection at the skull base. The hypoglossal neuropathy resulted from compression by the pseudoaneurysmal ICA dilatation or ischemia from interruption of the vasa nervorum.

Vagal Schwannoma

September 20, 2011     Regan W.J. Bergmark, BA, David P. Guo, BS, Harrison W. Lin, MD, William C. Faquin, MD, PhD, Geoffrey S. Young, MD, and Keith G. Saxon, MD
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A case of a coexisting aberrant internal carotid artery and persistent stapedial artery: The role of MR angiography in the diagnosis

April 30, 2011     Hatice Gul Hatipoglu, MD, Mehmet Ali Cetin, MD, Enis Yuksel, MD, and Huseyin Dere, MD
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Abstract

We describe the case of a 37-year-old woman who presented with a complaint of recurrent headaches since childhood. Clinical examination revealed the presence of a reddish-bluish mass in the inferior half of the tympanic membrane in her right ear. Source and three-dimensional time-of-flight magnetic resonance angiography (MRA) detected a protruded right internal carotid artery (ICA) in the hypotympanum. The vertical segment of the ICA was absent, and the artery was narrowed and lateralized and had a “reverse 7” shape. Meanwhile, a persistent stapedial artery (PSA) was seen originating in the petrous portion of the ICA to form a middle meningeal artery. The A1 segment of the right anterior cerebral artery was hypoplastic. Based on these findings and on follow-up findings on computed tomography, the patient was diagnosed with a concomitant aberrant ICA and PSA. No intervention was undertaken. We review the management of this rare finding, and we discuss the role of MRA in its diagnosis.

The use of a covered stent in carotid blowout syndrome

March 31, 2011     Brian McGettigan, MD, William Parkes, MD, Carin Gonsalves, MD, David Eschelman, MD, William Keane, MD, and Maurits S. Boon, MD
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Abstract

Rupture of the extracranial carotid arteries or their major branches is known as carotid blowout syndrome (CBS). CBS is a well-recognized complication of cancer of the head and neck and subsequent radiation therapy. A few treatment modalities are available, including open ligation and different endovascular techniques, but questions regarding both the immediate and delayed complications of these procedures persist. In this case report, we describe the management of acute CBS in a 54-year-old man who had previously been treated for follicular thyroid carcinoma. The patient was hemorrhaging from a pseudoaneurysm of the left common carotid artery. A self-expanding polytetrafluoroethylene (Teflon) -covered stent was successfully deployed endovascularly, and this resulted in cessation of the bleeding and restoration of flow through the vessel. We examine the covered-stent approach to treating acute CBS, and we discuss other treatment approaches that have been described in the literature.

Incomplete Horner syndrome: Report of a case and description of the sympathetic nervous system anatomy involved in Horner syndrome

February 1, 2011     Grant M. Garbo, MD, Alexander J. Harmatz, MD, and Glenn Isaacson, MD
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Abstract

Horner syndrome, in which ptosis, miosis, and anhidrosis occur concomitantly, can arise from injury to the sympathetic nerve pathways anywhere from the brain to the end organs. Incomplete Horner syndrome lacks the sign of anhidrosis. We present a case of incomplete Horner syndrome caused by internal carotid artery dissection and provide a road map of the cervical sympathetic nerves involved in Horner syndrome to explain its etiology. We also discuss the imaging of and therapy for internal carotid artery dissections.

An aberrant internal carotid artery discovered during evaluation of obstructive sleep apnea: A report of 2 cases with consideration of a possible association

January 1, 2011     Andrew C. Picel, MD and Terence M. Davidson, MD
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Abstract

Obstructive sleep apnea (OSA) is often associated with reduced pharyngeal muscle tone and an anatomically narrowed pharyngeal airspace. We describe 2 cases of aberrant internal carotid arteries that were diagnosed during evaluations of patients with suspected OSA. It is possible that these anatomic anomalies contributed to airspace narrowing in these patients. These 2 cases represent an interesting presentation of sleep apnea, and they provide a reminder of the importance of clinically recognizing carotid artery aberrations in order to avoid arterial damage during routine oropharyngeal procedures.

Aneurysm of the petrous portion of the internal carotid artery at the foramen lacerum: Anatomic, imaging, and otologic findings

June 30, 2010     Enrique Palacios, MD, FACR, Juan Gómez, MD, Jorge E. Alvernia, MD, and Christian Jacob, MD
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Abstract

Aneurysms of the petrous portion of the internal carotid artery (ICA) are rare. Their etiology is usually congenital, traumatic, or mycotic. Depending on the size and location of the aneurysm, the direction of its growth, and the specific adjacent structures involved, patients may or may not present with signs and symptoms. When signs and symptoms do manifest, they may include headaches, epistaxis, a vascular retrotympanic mass with hemotympanum and/or otorrhagia, pulsatile tinnitus, hearing loss, vertigo, and Horner syndrome or Raeder paratrigeminal neuralgia. We describe the imaging aspects of the case of a 27-year-old man who presented with a 5-day history of unilateral symptoms secondary to a lesion located in the area of the right foramen lacerum. The lesion proved to be an aneurysm of the petrous portion of the ICA. We discuss the anatomic, imaging, and otologic aspects of ICA aneurysms in this location.

Aberrant carotid artery as an incidental finding before tonsillectomy

April 30, 2010     Rabia Shihada, MD, Moshe Goldsher, MD, Jacob Braun, MD, and Michal Luntz, MD
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Abstract

Injury to the internal carotid artery during routine pharyngeal surgery is a rare and potentially catastrophic complication. Aberrations of the cervical blood vessels that might cause lethal post-tonsillectomy bleeding are clearly important but largely unpredictable, even when associated with pediatric head and neck syndromes. We describe a patient in whom aberrant cervical carotid artery was an incidental finding prior to a scheduled tonsillectomy.

Bilateral aberrant internal carotid artery

March 1, 2010     Christopher Y. Chang, MD
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