Tactics of Endovascular Treatment of External Craniofacial Bleeding

Dorohov P., Yakovlev S., Bocharov ., Buharin ., Arustamyan S., Kapitanov D.

Burdenko Research Institute of Neurosurgery, Moscow, Russia


The research goal was to estimate efficacy of endovascular treatment of external craniofacial bleeding (ECFB).

Material and Methods. There were 91 cases, aged 6-67, who were operated at the Research Institute of Neurosurgery in 1988-2005. Pathology in the external carotid artery region (ECA), Rendu-Osler disease, craniofacial tumors, traumatic lesion of the ECA branches were a cause of bleeding in 73 cases (80.3%). Bleeding was a result of traumatic false aneurysms of the internal carotid artery (ICA) in 18 patients (19.7%). A source of bleeding was revealed on the basis of angiographic data. Pathology in the ECA region was treated with superselective embolization of its branches by PVA microparticles; stationary balloon occlusion of the ICA at the level of its rupture was performed in case of its lesion and sufficient collateral blood flow. Traumatic false aneurysms of the cavernous ICA were diagnosed in 16 cases; they were located in its petrous segment in 2 patients. A volume of single blood loss was 0.5-2.5 l.

Results. The ECA embolization was characterized by relapses of nasal bleeding in 9 out of 73 cases (12.3%). It happened during 2 weeks after the procedure and demanded additional embolization. There were 4 patients with ligated ECA in a neck region. They underwent embolization with applying a direct retrograde approach via facial or superficial temporal arteries. There were no relapses of bleeding in the ICA occlusion at the level of false aneurysms. Embolisms of the middle cerebral artery, caused by thrombi migration from the false aneurysm cavity, was watched in 3 cases; 1 patient had embolism of the central artery of the retina. The mortality rate was 1.1%; persistent neurological deficit was present in 3.3% of cases.

Conclusion. Endovascular interventions with their selective effect on a source of bleeding are highly effective and can be recommended as an adequate method for treatment of ECFB.