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Bleeding was successfully controlled by inflating a Foley balloon catheter within the sphenoid sinus, and the patient was transferred to the authors\u2019 institution. Emergent angiography showed a dissection of the right cavernous carotid artery, with a large pseudoaneurysm projecting into the sphenoid sinus at the site of arterial injury. The right internal carotid artery was obliterated using pushable coils distally and an endovascular plug proximally. The endovascular plug enabled the authors to successfully exclude the pseudoaneurysm from the circulation. The patient subsequently underwent an emergent bifrontal craniotomy for evacuation of a left frontotemporal subdural empyema and exenteration of both frontal sinuses. He made a complete neurological recovery.<\/jats:p><jats:p>Endovascular large-vessel sacrifice, obviating the need for numerous coils and antiplatelet therapy, has a role in the setting of selected acute neurosurgical emergencies necessitating craniotomy. The endovascular plug is a useful adjunct in such circumstances as the device can be deployed rapidly, safely, and effectively.<\/jats:p>","DOI":"10.3171\/2017.3.peds16370","type":"journal-article","created":{"date-parts":[[2017,6,16]],"date-time":"2017-06-16T13:58:27Z","timestamp":1497621507000},"page":"239-246","source":"Crossref","is-referenced-by-count":3,"title":["Endovascular plug for internal carotid artery occlusion in the management of a cavernous pseudoaneurysm with bifrontal subdural empyema: technical note"],"prefix":"10.3171","volume":"20","author":[{"given":"Sunil","family":"Manjila","sequence":"first","affiliation":[{"name":"Division of Pediatric Neurosurgery, Rainbow Babies and Children\u2019s Hospital, Department of Neurological Surgery, The Neurological Institute, University Hospitals Case Medical Center;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gagandeep","family":"Singh","sequence":"additional","affiliation":[{"name":"Division of Interventional Neuroradiology, Department of Radiology, University Hospitals Case Medical Center, Cleveland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Obinna","family":"Ndubuizu","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Rainbow Babies and Children\u2019s Hospital, Department of Neurological Surgery, The Neurological Institute, University Hospitals Case Medical Center;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zoe","family":"Jones","sequence":"additional","affiliation":[{"name":"Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel P.","family":"Hsu","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Neuroscience Center, Redwood City, California; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan R.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Neurosurgery","first-page":"910","article-title":"Prevention of complications resulting from endovascular carotid sacrifice: a retrospective assessment","volume":"46","author":"Abruzzo T","year":"2000","unstructured":"Abruzzo T, Joseph GJ, Owens DS, Dawson RC III, Reid J, Barrow DL: Prevention of complications resulting from endovascular carotid sacrifice: a retrospective assessment. 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