Pseudoaneurysm of an aberrant internal carotid artery in the middle ear caused by myringotomy

An aberrant internal carotid artery (ICA) is a rare abnormality associated with life-threatening otorrhagia if inadvertently injured during middle-ear surgery including myringotomy. We present a case where a 3-year-old girl experienced massive otorrhagia following myringotomy, and computed tomographic scan showed the aberrant ICA. Bleeding was controlled by ear canal packing, but rebleeding occurred. Investigations by carotid angiography demonstrated a pseudoaneurysm of the aberrant ICA in the middle ear. We attempted surgical repair using a high-flow bypass technique; however, the bypass graft was occluded by embolic complications, and eventually, ligation of the ICA was performed, which led to the paralysis of the patient's left limbs. In this report, management of iatrogenic aberrant ICA injuries and pseudoaneurysms in the middle ear are discussed based on the case that we experienced.