Internal carotid artery hemorrhage after irradiation and osteoradionecrosis of the skull base.

OBJECTIVE

To evaluate the clinical presentation and management of internal carotid artery rupture after irradiation and osteoradionecrosis of the skull base.

STUDY DESIGN AND

SETTING

A retrospective review of the patients in an otorhinolaryngology-head and neck secondary and tertiary referral center.

METHODOLOGY: From January 1993 to December 1996, patients with hemorrhage from internal carotid artery as a complication of irradiation and osteoradionecrosis of skull base were reviewed and analyzed.

RESULTS

Four patients with internal carotid arterial rupture were included in this study. Angiography was performed in all cases. Embolization of the aneurysm was performed on 2 patients and the remaining 2 patients underwent occlusion of their internal carotid arteries. Three of the 4 patients did not survive. The fourth is currently alive and well 18 months after embolization of 1 internal carotid artery.

CONCLUSION

Skull base osteoradionecrosis with bleeding from internal carotid artery is a potentially fatal complication of irradiation. Angiography was the mainstay of diagnosis with embolization of the aneurysm and embolization or ligation of the internal carotid artery being the management options. Internal carotid artery occlusion is the definitive treatment provided cross circulation is adequate.

SIGNIFICANCE: The advantages and disadvantages of the treatment options are discussed and a management protocol is proposed.