scholarly journals Devastating iatrogenic internal carotid artery rupture in endoscopic endonasal surgery rescued by a covered stent

2021 ◽  
Vol 9 (8) ◽  
Author(s):  
Xiaojie Fu ◽  
Tao Quan ◽  
Yongjie Yuan ◽  
Haowen Xu ◽  
Sheng Guan
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Covered Stent ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Carotid Artery Rupture

scholarly journals Devastating iatrogenic internal carotid artery rupture in endoscopic endonasal surgery rescued by a covered stent

2020 ◽  
Author(s):  
Xiaojie Fu ◽  
Tao Quan ◽  
Yongjie Yuan ◽  
Haowen Xu ◽  
Sheng Guan
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Covered Stent ◽  
Therapeutic Strategies ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Carotid Artery Rupture

This paper reported a case of devastating iatrogenic ICA rupture in endoscopic endonasal surgery (EES) rescued by a covered stent. We also discussed the therapeutic strategies of iatrogenic ICA rupture in EES, which is of help in the management of this devastating complication.

Nasopharyngeal muscle patch for the management of internal carotid artery injury in endoscopic endonasal surgery

2020 ◽  
Vol 133 (5) ◽  
pp. 1382-1387 ◽  
Author(s):  
Wei-Hsin Wang ◽  
Stefan Lieber ◽  
Ming-Ying Lan ◽  
Eric W. Wang ◽  
Juan C. Fernandez-Miranda ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Internal Carotid ◽  
Skull Base Surgery ◽  
Management Technique ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Muscle Graft

OBJECTIVEInjury to the internal carotid artery (ICA) is the most critical complication of endoscopic endonasal skull base surgery. Packing with a crushed muscle graft at the injury site has been an effective management technique to control bleeding without ICA sacrifice. Obtaining the muscle graft has typically required access to another surgical site, however. To address this concern, the authors investigated the application of an endonasally harvested longus capitis muscle patch for the management of ICA injury.METHODSOne colored silicone-injected anatomical specimen was dissected to replicate the surgical access to the nasopharynx and the stepwise dissection of the longus capitis muscle in the nasopharynx. Two representative cases were selected to illustrate the application of the longus capitis muscle patch and the relevance of clinical considerations.RESULTSA suitable muscle graft from the longus capitis muscle could be easily and quickly harvested during endoscopic endonasal skull base surgery. In the illustrative cases, the longus capitis muscle patch was successfully used for secondary prevention of pseudoaneurysm formation following primary bleeding control on the site of ICA injury.CONCLUSIONSNasopharyngeal harvest of a longus capitis muscle graft is a safe and practical method to manage ICA injury during endoscopic endonasal surgery.

Internal carotid artery injury in endoscopic endonasal surgery: A systematic review

2015 ◽  
Vol 126 (3) ◽  
pp. 582-590 ◽  
Author(s):  
Oliver Y. Chin ◽  
Ritam Ghosh ◽  
Christina H. Fang ◽  
Soly Baredes ◽  
James K. Liu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Carotid Artery Injury ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Artery Injury ◽  
Internal Carotid Artery Injury

scholarly journals A Case of Pseudoaneurysm of the Internal Carotid Artery Following Endoscopic Endonasal Pituitary Surgery: Endovascular Treatment with Flow-Diverting Stent Implantation

2017 ◽  
Vol 60 (2) ◽  
pp. 89-92 ◽  
Author(s):  
Ali Karadag ◽  
Burak Kinali ◽  
Omer Ugur ◽  
Ismail Oran ◽  
Erik H. Middlebrooks ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Ct Angiography ◽  
Stent Implantation ◽  
Internal Carotid ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Flow Diverting Stent

Internal carotid artery (ICA) pseudoaneurysm is a rare complication of endoscopic endonasal surgery occurring in 0.4–1.1% of cases. Pseudoaneurysms can subsequently result in other complications, such as subarachnoid hemorrhage, epistaxis, and caroticocavernous fistula with resultant death or permanent neurologic deficit. In this case, we illustrate endovascular treatment with a flow-diverting stent for an ICA pseudoaneurysm after endoscopic endonasal surgery for a pituitary adenoma in a 56-year-old male. Surgery was complicated by excessive intraoperative bleeding and emergent CT angiography confirmed an iatrogenic pseudoaneurysm on the anteromedial surface of the ICA. The pseudoaneurysm was treated endovascularly with flow-diverting stent implantation only. Follow-up CT angiography after three months demonstrated occlusion of the pseudoaneurysm.

Identifying Best Practices for Managing Internal Carotid Artery Injury During Endoscopic Endonasal Surgery by Consensus of Expert Opinion

2021 ◽  
pp. 194589242110248
Author(s):  
Zachary M. Kassir ◽  
Paul A. Gardner ◽  
Eric W. Wang ◽  
Georgios A. Zenonos ◽  
Carl H. Snyderman
Keyword(s):  
Carotid Artery ◽  
Best Practices ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Internal Carotid ◽  
Consensus Statement ◽  
Carotid Artery Injury ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal

Background Injury to the internal carotid artery (ICA) is a potentially devastating complication of endoscopic endonasal surgery (EES) that as many as 20% of skull base surgeons will experience at least once during their careers. Managing these injuries is difficult given the small operative field and poor visibility created by high-flow hemorrhage, and, at present, there is no consensus regarding best practices. Objective This study seeks to consolidate the practices and opinions of experienced skull base surgeons from high-volume tertiary care centers into a single consensus statement regarding the best practices for managing ICA injuries during EES. Methods A panel of 23 skull base surgeons (15 neurosurgeons and 8 otolaryngologists) completed a 3-round Delphi survey that assessed experiences and opinions regarding various aspects of ICA injury management. Mean (SD) years since fellowship completion was 15.6 (8.1) and all but 3 surgeons had experienced an ICA injury at least once. Results The final consensus statement included 36 guidelines all of which were grouped under 1 of 4 categories: 11 statements concerned preoperative management and equipment for high-risk patients; 14 statements concerned hemorrhage control; 4 statements concerned definitive management; 7 statements concerned pharmacologic treatment, blood pressure, and neurophysiologic monitoring. Conclusions There are numerous decisions that a surgeon must make when facing a carotid artery injury. In our estimation, many questions can be grouped under 1 of the 4 categories outlined in our consensus statement and can be addressed by these findings.

A modified endovascular treatment protocol for iatrogenic internal carotid artery injuries following endoscopic endonasal surgery

2020 ◽  
Vol 132 (2) ◽  
pp. 343-350 ◽  
Author(s):  
Yisen Zhang ◽  
Zhongbin Tian ◽  
Chuzhong Li ◽  
Jian Liu ◽  
Ying Zhang ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Endovascular Treatment ◽  
Internal Carotid ◽  
Treatment Protocol ◽  
Covered Stent ◽  
Endoscopic Endonasal Surgery ◽  
Detachable Balloon ◽  
Endoscopic Endonasal ◽  
Covered Stent Graft ◽  
Preservation Rate

OBJECTIVEInternal carotid artery (ICA) injuries during endoscopic endonasal surgery (EES) are catastrophic complications. Alongside the advancements in medical instrumentation and material, there is a need to modify previous treatment modalities and principles.METHODSA retrospective review of 3658 patients who underwent EES performed at the authors’ institution between January 2012 and December 2017 was conducted. Ultimately, 20 patients (0.55%) with ICA injury following EES were enrolled for analysis. Data collection included demographic data, preoperative diagnosis, injury setting, repair method, and immediate and follow-up angiographic and clinical outcomes.RESULTSAmong the 20 patients, 11 received immediate endovascular therapy and 9 were treated only with packing. Of the 11 patients who received endovascular treatment, 6 were treated by covered stent and 5 by parent artery occlusion (PAO). The preservation rate of injured ICA increased from 20.0% (1 of 5) to 83.3% (5 of 6) after the Willis covered stent graft became available in January 2016. Of the 20 patients in the study, 19 recovered well and 1 patient—who had a pseudoaneurysm and was treated by PAO with a detachable balloon—suffered epistaxis after the hemostat in her nasal cavity was removed in ward, and she died later that day. The authors speculated that the detachable balloon had shifted to the distal part of ICA, although the patient could not undergo a repeat angiogram because she quickly suffered shock and could not be transferred to the catheter room. After the introduction of a hybrid operating room (OR), one patient whose first angiogram showed no ICA injury was found to have a pseudoaneurysm. He received endovascular treatment when he was brought for a repeat angiogram 5 days later in the hybrid OR after removing the hemostat in his nasal cavity. Of the 4 surviving patients treated with PAO, no external carotid artery–ICA bypass was required. The authors propose a modified endovascular treatment protocol for ICA injuries suffered during EES that exploits the advantage of the covered stent graft and the hybrid OR.CONCLUSIONSThe endovascular treatment protocol used in this study for ICA injuries during EES was helpful in the management of this rare complication. Willis stent placement improved the preservation rate of injured ICA during EES. It would be highly advantageous to manage this complication in a hybrid OR or by a mobile C-arm to get a clear intraoperative angiogram.

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