EC–IC Bypass for Skull Base Necrosis and ICA Rupture Hemorrhage After Radiotherapy for Nasopharyngeal Carcinoma

ABSTRACT Background Skull base necrosis can cause life‐threatening massive bleeding in patients following radiotherapy and chemotherapy for nasopharyngeal carcinoma. Patients with bilateral internal carotid artery rupture and hemorrhage are especially susceptible, which is a major challenge for clinicians. Methods A team at the Eye and ENT Hospital affiliated with Fudan University recently successfully treated a patient with skull base necrosis after radiotherapy and chemotherapy for nasopharyngeal carcinoma. The patient experienced bilateral internal carotid artery rupture with massive nasopharyngeal hemorrhage and was treated with extracranial–intracranial bypass surgery, resection of the nasal skull base necrotic lesions, and bilateral internal carotid artery occlusion. Results One week after the last surgery, the patient recovered well, and normal activity was restored. Conclusions Simultaneous EC–IC bypass and TMF repair increase intracranial blood flow compensation without the need for an additional incision, saving the patient's life and improving their quality of life. These results highlight a promising surgical practice for rescuing patients suffering from skull base necrosis and ICA rupture hemorrhage.