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Flow-diverter in radiation-induced skull base carotid blowout syndrome: do not write it off!

Flow-diverter in radiation-induced skull base carotid blowout syndrome: do not write it off!
Author Information (click to view)

Anil G, Zhang J, Ong YK, Hui F,


Anil G, Zhang J, Ong YK, Hui F, (click to view)

Anil G, Zhang J, Ong YK, Hui F,

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Neurosurgical review 2017 07 16() doi 10.1007/s10143-017-0875-3
Abstract

Post-radiotherapy carotid blowout syndrome (CBS) of the skull base is a rare but often catastrophic complication of head and neck malignancies. The existing literature on the treatment of this condition with flow-diverting devices (FDD) is extremely limited and disappointing. We present a case of impending CBS in a patient previously irradiated for nasopharyngeal cancer that was successfully treated with use of multiple FDDs, adjunctive endonasal packing and delayed reinforcement with pedicled naso-septal flap, yielding an excellent outcome at 14-months follow-up. Notwithstanding the discouraging results in literature, our anecdotal experience suggests that endovascular reconstruction using FDD could be an option with long-term viability in post-radiotherapy CBS involving the skull base when reinforced with a vascularised naso-septal flap.

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