Rupture from cavernous internal carotid artery pseudoaneurysm 11 years after transsphenoidal surgery.

• Pseudoaneurysm formation can occur more than a decade after transsphenoidal surgery. • Psuedoaneurysm rupture should be considered with epistaxis regardless of time course. • Endovascular treatment options include combination coiling and flow-diversion stent placement. Carotid artery pseudoaneurysm is a rare complication of transsphenoidal surgery, usually diagnosed within 90 days post procedure. Sequelae of pseudoaneurysm rupture, such as severe epistaxis or carotid cavernous fistula (CCF), have significant morbidity and mortality. A case of epistaxis from pseudoaneurysm rupture over a decade after transsphenoidal surgery is presented, with staged treatment using coiling, endonasal mucosal flap repair and interval flow-diverting stent insertion. This case illustrates that pseudoaneurysm rupture occurs regardless of time course after transsphenoidal surgery, and treatment strategies using combined endovascular and endonasal techniques are reviewed. [ABSTRACT FROM AUTHOR]