PMC9879062_01
(A) MRI showed that nasopharyngeal carcinoma invaded the left postnaris, pterygopalatine fossa, cavernous sinus and skull base. (B) Morphological observation by HE staining was consistent with the diagnosis of undifferentiated non-keratinizing nasopharyngeal carcinoma, with no Keratinized beads of squamous cell carcinoma positive staining. Bar, 50 mum.
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F1
A 40-year-old male was diagnosed with pathologically confirmed nasopharyngeal carcinoma (T4N2M0, undifferentiated non-keratinizing carcinoma) (Figure 1). Time line of the clinical course was shown in Supplementary Figure S1.
(A) bilateral external carotid arteries embolization with spring coil (red arrow). (B) Angiography suggests a narrow neck pseudoaneurysm in the right internal carotid artery rupture hole segment, diameter about 9.6 X 15.7 mm (red arrow). (C) Extravasation (blue arrow) of contrast medium into the nasal cavity was seen at the base, lateral and neck part of the aneurysm; The microcatheter was delivered into the aneurysm cavity, and the balloon (yellow arrow) was guided to the C4 segment and opened with a certain pressure to temporarily block the right internal carotid artery to prevent the thrombus from dislodging. Five spring coils (red arrow) were then sequentially placed and released in the aneurysm lumen via a microcatheter, and the imaging showed that the spring coils were well formed in the aneurysm lumen. (D) After imaging, we still saw extravasation (red arrow) of contrast into the sinus, and continued to use ONYX gel to fill and seal the fistula. (E) The imaging shows complete occlusion of the fistula (red arrow) and arterial stent (blue arrow) well released. (F) Well reconstruction of the internal carotid artery (red arrow) on imaging and the purpose of embolization is achieved.
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F2
Time line of the clinical course was shown in Supplementary Figure S2.
PMC9879062_02
(A) bilateral external carotid arteries embolization with spring coil (red arrow). (B) Angiography suggests a narrow neck pseudoaneurysm in the right internal carotid artery rupture hole segment, diameter about 9.6 X 15.7 mm (red arrow). (C) Extravasation (blue arrow) of contrast medium into the nasal cavity was seen at the base, lateral and neck part of the aneurysm; The microcatheter was delivered into the aneurysm cavity, and the balloon (yellow arrow) was guided to the C4 segment and opened with a certain pressure to temporarily block the right internal carotid artery to prevent the thrombus from dislodging. Five spring coils (red arrow) were then sequentially placed and released in the aneurysm lumen via a microcatheter, and the imaging showed that the spring coils were well formed in the aneurysm lumen. (D) After imaging, we still saw extravasation (red arrow) of contrast into the sinus, and continued to use ONYX gel to fill and seal the fistula. (E) The imaging shows complete occlusion of the fistula (red arrow) and arterial stent (blue arrow) well released. (F) Well reconstruction of the internal carotid artery (red arrow) on imaging and the purpose of embolization is achieved.
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F2
Time line of the clinical course was shown in Supplementary Figure S2.
(A) the DSA examination showed that the pseudoaneurysm (red arrow) of the internal carotid artery located in the ruptured orifice segment of the right internal carotid artery, with a diameter of about 6*7 mm. The stenosis (blue arrow) of the cavernous sinus segment of the right internal carotid artery was about 50%. (B) With the assistance of stent and balloon, the pseudoaneurysm (red arrow) was successfully embolized with spring coils and ONXY gel. (C) Well reconstruction of the internal carotid artery (red arrow) on imaging. (D) The recurrent pseudoaneurysm (red arrow) located in the C2-4 segment of the right internal carotid artery, with a diameter of about 20*18.8 mm and a lobulated round shape. (E) After assessing the compensation of the internal carotid artery on the affected side by compression neck test, we completely and permanently occluded the right internal carotid artery (red arrow) with the aid of a balloon using spring coil and ONYX gel. (F) The anterior communicating artery (red arrow) was completely opened on the compression neck test.
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F3
The operation procedure details were shown in Figure 3.