Traumatic pseudoaneurysm of the foramen lacerum segment of the internal carotid artery in the acute phase:a case report

LIU Jian-wu; ZHANG Zhen-yu; HU Kun

doi:10.13798/j.issn.1009-153X.2025.04.013

Abstract：Traumatic pseudoaneurysms are rare in the early stages of trauma.Due to the close anatomical relationship between the internal carotid artery(ICA)and the skull base,traumatic pseudoaneurysms predominantly occur in the cavernous and petrous segments of the ICA,while the foramen lacerum segment is relatively uncommon.This paper reports a case of a 34-year-old male who developed a traumatic pseudoaneurysm at the foramen lacerum segment of the ICA complicated by an intracranial hematoma in the early post-trauma phase.The patient was admitted with headache,ear/nose bleeding,and CSF leakage for 2 hours following a traffic accident.On admission,he was drowsy with a GCS score of 14.Emergency CT revealed subarachnoid hemorrhage,intracranial pneumocephalus,and fractures of the right temporal bone and skull base.Approximately 8 minutes later,he experienced sudden epistaxis and oronasal bleeding(approximately 150 ml)with decreased consciousness(GCS 5).Head and neck CTA demonstrated a new right temporo-parieto-occipital epidural hematoma and a pseudoaneurysm at the foramen lacerum segment of the right ICA.Emergency bare coil embolization of the pseudoaneurysm was performed under general anesthesia,achieving satisfactory occlusion,followed sequentially by evacuation of the epidural hematoma.One-week postoperative cerebral angiography revealed recurrence of the pseudoaneurysm,prompting covered stent placement.One-year follow-up angiography demonstrated sustained vessel patency without recurrence.This case suggests that for patients with pseudoaneurysms complicated by intracranial hematomas requiring surgery,initial management with simple coil embolization of the pseudoaneurysm plus hematoma evacuation,followed by staged covered stent placement after intracranial stabilization,is a safe and effective approach.