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 sku ll base. STUDY DESIGN AND SETTING: A retrospective review of the patients in an otor hinolaryngology-head and neck secondary and tertiary referral center. METHODOLOGY: From January 1993 to December 1996, patients with hemorrhage f rom internal carotid artery as a complication of irradiation and osteoradio necrosis 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 underwen t occlusion of their internal carotid arteries. Three of the 4 patients did not survive. The fourth is currently alive and well 18 months after emboli zation of I internal carotid artery. CONCLUSION: Skull base osteoradionecrosis with bleeding from internal carot id artery is a potentially fatal complication of irradiation. Angiography w as the mainstay of diagnosis with embolization of the aneurysm and emboliza tion or ligation of the internal carotid artery being the management option s. Internal carotid artery occlusion is the definitive treatment provided c ross circulation is adequate. SIGNIFICANCE. The advantages and disadvantages of the treatment options are discussed and a management protocol is proposed.