Abstract
Post-radiotherapy carotid blowout syndrome (CBS) of the skull base is a rare but often catastrophic complication of head and neck malignancies. The existing literature on the treatment of this condition with flow-diverting devices (FDD) is extremely limited and disappointing. We present a case of impending CBS in a patient previously irradiated for nasopharyngeal cancer that was successfully treated with use of multiple FDDs, adjunctive endonasal packing and delayed reinforcement with pedicled naso-septal flap, yielding an excellent outcome at 14-months follow-up. Notwithstanding the discouraging results in literature, our anecdotal experience suggests that endovascular reconstruction using FDD could be an option with long-term viability in post-radiotherapy CBS involving the skull base when reinforced with a vascularised naso-septal flap.
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References
Chaloupka JC, Putman CM, Citardi MJ, Ross DA, Sasaki CT (1996) Endovascular therapy for the carotid blowout syndrome in head and neck surgical patients: diagnostic and managerial considerations. AJNR Am J Neuroradiol 17(5):843–852
Wan WS, Lai V, Lau HY, Wong YC, Poon WL, Tan CB (2013) Endovascular treatment paradigm of carotid blowout syndrome: review of 8-years experience. Eur J Radiol 82(1):95–99
Wong GK, Poon WS (2013) Why current evidence is against flow diverters for treatment of carotid blowout syndrome. Eur J Radiol 82(1):191
Tsang AC, Leung KM, Lee R, Lui WM, Leung GK (2015) Primary endovascular treatment of post-irradiated carotid pseudoaneurysm at the skull base with the pipeline embolization device. J Neurointerv Surg 7(8):603–607
Shah H, Gemmete JJ, Chaudhary N, Pandey AS, Ansari SA (2011) Acute life-threatening hemorrhage in patients with head and neck cancer presenting with carotid blowout syndrome: follow-up results after initial hemostasis with covered-stent placement. AJNR Am J Neuroradiol 32(4):743–747
Sylvester PT, Moran CJ, Derdeyn CP, Cross DT, Dacey RG, Zipfel GJ et al (2016 Nov) Endovascular management of internal carotid artery injuries secondary to endonasal surgery: case series and review of the literature. J Neurosurg 125(5):1256–1276
Lai V, Wan WS (2013) Reply to letter to the editor “why current evidence is against flow diverters for treatment of carotid blowout syndrome”. Eur J Radiol 82(1):192
Chen KC, Yen TT, Hsieh YL, Chen HC, Jiang RS, Chen WH et al (2015) Postirradiated carotid blowout syndrome in patients with nasopharyngeal carcinoma: a case-control study. Head Neck 37(6):794–799
Lam JW, Chan JY, Lui WM, Ho WK, Lee R, Tsang RK (2014) Management of pseudoaneurysms of the internal carotid artery in postirradiated nasopharyngeal carcinoma patients. Laryngoscope 124(10):2292–2296
Adel M, Chang KP (2016) Using a nasoseptal flap for the reconstruction of osteoradionecrosis in nasopharyngeal carcinoma: a case report. J Otolaryngol Head Neck Surg 45:27
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Anil, G., Zhang, J., Ong, Y.K. et al. Flow-diverter in radiation-induced skull base carotid blowout syndrome: do not write it off!. Neurosurg Rev 40, 685–688 (2017). https://doi.org/10.1007/s10143-017-0875-3
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DOI: https://doi.org/10.1007/s10143-017-0875-3