Treatment Dilemma of Latrogenic Pseudoaneurysm of the Intracavernous Internal Carotid Artery in Young Girl Following Transnasal Transsphenoidal Surgery: A Case Report.

Epistaxis following transnasal transsphenoidal (TNTS) removal of pituitary adenoma can be massive and life-threatening. The intracranial source of bleeding is usually the intracavernous segment of the internal carotid artery (ICA) or adjacent branches. Injury to the cavernous ICA can lead to pseudoaneurysm (PA) or fistula formation. Management of PA is different from saccular aneurysms. A timely diagnosis and adequate management can restore vessel integrity and prevent associated morbidity. A young patient of growth hormone-secreting pituitary adenoma, who underwent microscopic TNTS excision of the tumour, presented with massive epistaxis. Pseudoaneurysm of the cavernous ICA was initially not seen on computed tomography angiography and was later diagnosed on digital subtraction angiography. The attempted management of PA with coils without stent could not stop aneurysm recurrence. The management of such complicated PAs is discussed, and a literature review is done regarding epistaxis in growth hormone secreting adenoma.

Nasopharyngeal rhinosporidiosis with intracranial extension masquerading as juvenile angiofibroma: an unusual entity.

Rhinosporidiosis is a chronic fungal inflammatory disease prevalent in India and Sri Lanka. Its manifestations are mostly nasal and extranasal lesions are relatively rare. Occasional atypical presentations of this disease lead to diagnostic dilemma. Herein we report on a case of nasopharyngeal rhinosporidiosis having extensive involvement of paranasal sinuses along with intracranial extension which mimicked radiologically as juvenile nasopharyngeal angiofibroma. To our knowledge, this is the first reported case of rhinosporidiosis having intracranial extension. We discuss the pathology, treatment and briefly review the literature of this rare disease.

Dissection of C2 Guiding to C1 Lateral Mass and Facilitation of Screw Placement: Technical Note.

OBJECTIVE: Surgical intervention at the craniovertebral junction requires preoperative and intraoperative planning to get optimum postoperative results. Careful positioning minimizes the risk of iatrogenic injury and can also facilitate adequate surgical exposure. Tortuous venous channels that are usually encountered as the dissection proceeds may cause excessive bleeding before reaching the lateral mass (LM). However, both localization and placement may be made easier by altering the dissection technique and modifying the patient's position. Traditionally, the military tuck position is described for the dorsal approach to the craniovertebral junction. The objective of this study is to emphasize the role of arc or bow like position, a modification of prone position for adequate placement of C1 LM screw in these cases. METHODS: We operated on 68 patients with atlantoaxial dislocation in an arc or bow position from January 2013 to September 2018. In 58 patients, at least 1 C1 LM screw was placed. RESULTS: This position helped in easy and early recognition with easy trajectory for the C1 LM screw placement and less work force. CONCLUSIONS: Visual axis to the lateral mass of C1 in an arc/bow position with head elevation puts C1 LM more in the visual axis of the operator, which makes the trajectory straight without causing much angulation while inserting the screw. At the same time, the axis vertebra guides the surgeon to the C1 lateral mass with no handling of dura.