Embolization after internal carotid artery injury secondary to transsphenoidal pituitary surgery and delayed intranasal coil protrusion: illustrative case

J Neurosurg Case Lessons. 2022 Jun 6;3(23):CASE2215. doi: 10.3171/CASE2215.

Abstract

Background: The authors presented a case of spontaneous nasopharyngeal coil migration that occurred 3 years after a patient had undergone transsphenoidal resection due to pituitary macroadenoma and was treated with coil application because of internal carotid artery injury secondary to transsphenoidal resection of the pituitary macroadenoma.

Observations: In the literature, eight cases of coil migration that occurred between 2 and 120 months after coil application have been reported, most of which were treated with surgical removal of the coil in a same-day surgery setting.

Lessons: The case presented emphasized that coil protrusion and migration may lead to destruction in the skull base, thereby leading to serious consequences if left untreated, even in the absence of history of trauma. To the authors' knowledge, this is the first case in the literature that required additional invasive procedures due to recurrent bleeding that occurred several months after surgical removal of coils. Also, this report underlined the need for careful and long-term follow-up of coil materials used for the treatment of pseudoaneurysms caused by vascular injuries secondary to skull base injury during surgery.

Keywords: CT = computed tomography; DSA = digital subtraction angiography; ENT = ear-nose-throat; ICA = internal carotid artery; MRA = magnetic resonance angiography; MRI = magnetic resonance imaging; coil extrusion; embolization; endoscopic endonasal approach; internal carotid artery injury.

Publication types

  • Case Reports