Traumatic Anterior Ethmoidal Artery Pseudoaneurysm with Repeated Epistaxis Treated by Transarterial Embolization: A Case Report

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  • Kuranari Yuki
    Department of Neurosurgery, Keio University Hospital, Tokyo, Japan
  • Akiyama Takenori
    Department of Neurosurgery, Keio University Hospital, Tokyo, Japan
  • Yanagisawa Kaoru
    Department of Neurosurgery, Keio University Hospital, Tokyo, Japan
  • Kamamoto Dai
    Department of Neurosurgery, Keio University Hospital, Tokyo, Japan
  • Mizutani Katsuhiro
    Department of Neurosurgery, Keio University Hospital, Tokyo, Japan
  • Takahashi Satoshi
    Department of Neurosurgery, Keio University Hospital, Tokyo, Japan
  • Saito Shin
    Department of Otorhinolaryngology, Keio University Hospital, Tokyo, Japan
  • Ozawa Hiroyuki
    Department of Otorhinolaryngology, Keio University Hospital, Tokyo, Japan
  • Ogawa Kaoru
    Department of Otorhinolaryngology, Keio University Hospital, Tokyo, Japan
  • Yoshida Kazunari
    Department of Neurosurgery, Keio University Hospital, Tokyo, Japan

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  • Case Report : Traumatic Anterior Ethmoidal Artery Pseudoaneurysm with Repeated Epistaxis Treated by Transarterial Embolization : A Case Report

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<p>Objective: Pseudoaneurysms of the internal carotid artery (ICA) and sphenopalatine artery (SPA) are recognized as sources of arterial epistaxis following head and face trauma. However, epistaxis involving pseudoaneurysm of the anterior ethmoidal artery (AEA) is extremely rare.</p><p>Case Presentation: A 25-year-old man experienced massive epistaxis due to a ruptured traumatic pseudoaneurysm of the AEA. The patient had suffered head and face trauma in a car accident. CT showed fractures of the frontal, ethmoidal, and maxillary bones, and he was managed conservatively. Nine days after the injury, he had sudden, massive epistaxis. Angiography showed a right AEA aneurysm, which was treated successfully with transarterial embolization using n-butyl-2-cyanoacrylate (NBCA).</p><p>Conclusion: Although pseudoaneurysm of the AEA is a rare cause of epistaxis, it is important to consider this diagnosis, in addition to pseudoaneurysm of the SPA and ICA, when a patient has massive arterial epistaxis following a traumatic skull base fracture, especially if the fracture is adjacent to the ethmoid sinus. Transarterial embolization using glue is a feasible therapeutic option for this condition.</p>

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