HEMORRHAGE FROM AN INTRAPETROUS CAROTID-ARTERY ANEURYSM OCCURRING AFTER MYRINGOTOMY

Aneurysms of the temporal part of the carotid artery are unusually rar e. The literature contains only a few previous reports dealing with he morrhage from such malformations. In the present case massive bleeding occurred from a right-sided intrapetrous aneurym after myringotomy, w hich was performed as treatment far bilateral secretory otitis media. Due to the absence of any specific symptoms and the masking effect of middle ear glue preoperative identification of the aneurysm was not po ssible. Subsequent angiography showed the large fusiform extension of the intrapetrous aneurysm as well as multiple intracranial aneurysms. Leakage from the aneurism was closed definitively with muscle,fascia l ata and a gelatin-resorcin-formalin-glue (Cardial(R)). In order to app ly the tissue patch the hypotympanic site of the aneurism was exposed using a posterior otosurgical approach. Due to extensive intracranial collateralization to the Vertebral arteries bleeding persisted even af ter ligation of both carotid arteries. Temporary cardiac asystole was then induced to allow safe closure of the aneurysm. Following surgery the patient sustained loss of hearing in her ear and a partial periphe ral facial palsy.