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내경동맥의 가성동맥류가 동반된 측두골 방사선골괴사 1례

A Case of Temporal Bone Osteoradionecrosis Accompanied by Internal Carotid Artery Pseudoaneurysm

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주제분류이비인후과학

초록

Radiation therapy plays a critical role in treating head and neck malignancies. However, it is associated with the potential for severe complications, including the development of osteoradionecrosis (ORN). An uncommon consequence of ORN is the emergence of pseudoaneurysms within the internal carotid artery (ICA). Pseudoaneurysms of the petrous ICA resulting from temporal ORN can lead to life-threatening bleeding, necessitating prompt interventions such as coiling, stenting, and carotid sacrifice. In instances where there exists a high risk of ICA rupture, a combination of these therapeutic approaches might be indispensable to prevent serious complications and enhance the well-being of the patients. We present a case involving a pseudoaneurysm within the petrous segment of the ICA caused by ORN. The treatment consisted of coil embolization coupled with subtotal petrosectomy and partial labyrinthectomy. Despite an initial treatment, recurrence occurred within two months, prompting the subsequent implementation of stent insertion with revisional subtotal petrosectomy.

Abstract

Radiation therapy plays a critical role in treating head and neck malignancies. However, it is associated with the potential for severe complications, including the development of osteoradionecrosis (ORN). An uncommon consequence of ORN is the emergence of pseudoaneurysms within the internal carotid artery (ICA). Pseudoaneurysms of the petrous ICA resulting from temporal ORN can lead to life-threatening bleeding, necessitating prompt interventions such as coiling, stenting, and carotid sacrifice. In instances where there exists a high risk of ICA rupture, a combination of these therapeutic approaches might be indispensable to prevent serious complications and enhance the well-being of the patients. We present a case involving a pseudoaneurysm within the petrous segment of the ICA caused by ORN. The treatment consisted of coil embolization coupled with subtotal petrosectomy and partial labyrinthectomy. Despite an initial treatment, recurrence occurred within two months, prompting the subsequent implementation of stent insertion with revisional subtotal petrosectomy.

참고문헌 (7)

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  3. Huang XM, "Diagnosis and management of skull base osteoradionecrosis after radiotherapy for nasopharyngeal carcinoma", Laryngoscope, 116(9), pp.1626~1631 (2006)
  4. Chen MY, "Clinical findings and imaging features of 67 nasopharyngeal carcinoma patients with postradiation nasopharyngeal necrosis", Chin J Cancer, 32(10), pp.533~538 (2013)
  5. Curi MM, "Histopathologic and histomorphometric analysis of irradiation injury in bone and the surrounding soft tissues of the jaws", J Oral Maxillofac Surg, 74(1), pp.190~199 (2016)
  6. Liu J, "Endoscopic sequestrectomy for skull base osteoradionecrosis in nasopharyngeal carcinoma patients : a 10‑year experience", Int J Clin Oncol, 24(3), pp.248~255 (2019)
  7. Maras D, "Covered stent-graft treatment of traumatic internal carotid artery pseudoaneurysms : a review", Cardiovasc Interv Radiol, 29(6), pp.958~968 (2006)

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