Iatrogenic pseudoaneurysm formation in the medial orbitofrontal artery following rhinoplasty and nasal osteotomy: A case report

Background: Intracranial vascular complications following rhinoplasty are exceptionally rare but may result in devastating neurological outcomes. We report a rare case of iatrogenic pseudoaneurysm of the medial orbitofrontal artery after rhinoplasty with nasal osteotomy. Case Description: A 31-year-old man presented with postoperative intracerebral hemorrhage shortly after rhinoplasty. Digital subtraction angiography demonstrated a pseudoaneurysm arising from the medial orbitofrontal artery. The patient underwent microsurgical trapping and clipping of the pseudoaneurysm with simultaneous repair of an associated cribriform plate defect and cerebrospinal fluid leakage, resulting in complete exclusion of the lesion and an uneventful neurological recovery. Postoperatively, he recovered without neurological deficits and remained clinically stable during follow-up. Conclusion: Although extremely uncommon, intracranial pseudoaneurysm should be considered in patients who develop intracerebral hemorrhage after rhinoplasty. Prompt vascular imaging and timely neurosurgical intervention are essential to prevent potentially catastrophic complications and achieve favorable outcomes.