Abstract
Although vasculitis due to infection with fungi, including Aspergillus, causes aneurysm formation, reports of internal carotid artery aneurysm formation
resulting from fungal sinusitis are few. We report on a patient who experienced massive
epistaxis from rupture of an internal carotid artery pseudoaneurysm, caused by fungal
sinusitis. We treated the aneurysm with endovascular coil embolization, followed by
endoscopic sinus surgery to remove the fungal mass. Intraoperative findings included
a torn internal carotid artery and exposure of the coil to the sinus. Performing endoscopic
sinus surgery before the embolization procedure would have increased the risks of
massive intraoperative bleeding and mortality. Even after achieving hemostasis, serious
sequelae, such as cerebral infarction, might occur. In this type of case, otorhinolaryngologists
and neurosurgeons should collaborate, and an aneurysm should be treated before endoscopic
sinus surgery. Although the treatment strategy for fungal internal carotid artery
aneurysms is controversial, this case suggested the use of the embolization procedure
followed by endoscopic debridement and antifungal therapy to treat a pseudoaneurysm
of the internal carotid artery caused by fungal sinusitis.
Keywords
Abbreviations:
g/dL (grams per decilitre), CT (computed tomography), MRI (magnetic resonance imaging), MRA (magnetic resonance angiography)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 06, 2023
Accepted:
December 27,
2022
Received:
October 23,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Japanese Society of Otorhinolaryngology-Head and Neck Surgery, Inc. Published by Elsevier B.V. All rights reserved.
