Management of Internal Carotid Artery Injury During Transsphenoidal Surgery: A Case Series and Suggestion for Optimal Management
- Alternative Title
- Management of Internal Carotid Artery Injury During Transsphenoidal Surgery: A Case Series and Suggestion for Optimal Management
- Abstract
- Objective: Internal carotid artery (ICA) injury during transsphenoidal surgery is a rare but serious complication. We analyzed a series of ICA injuries that occurred during a transsphenoidal approach to suggest an optimal management strategy.
Methods: Between January 2015 and May 2020, we enrolled 10 cases of ICA injury at our institution.
Results: Among the 10 patients enrolled, 5 had pituitary adenoma, 2 had craniopharyngioma, and 1 each had skull base chondrosarcoma, tuberculum sellae meningioma, and nasopharyngeal cancer; 4 were revision surgery cases. The cavernous segment of the ICA was the most commonly injured area. The most common reason for ICA injury was a drill injury at the sellar floor opening. A direct repair was performed using a clip in only 1 patient. In the others, bleeding control of the injured ICA was achieved by packing multiple cotton pads. After angiography, 6 patients underwent immediate endovascular sacrifice of the injured ICA. In 3 patients who showed poor collateral flow from the anterior communicating and posterior communicating arteries, revascularization surgery was performed before endovascular trapping. After 6 postoperative months, 6 patients showed favorable functional outcomes, and 4 patients showed poor functional outcomes.
Conclusions: Prompt control of bleeding, endovascular management of injured ICA, and consideration of revascularization surgery based on collateral flow may prevent catastrophic neurological sequelae.
- Author(s)
- Chang Ki Hong; Joonho Byun; Wonhyoung Park; Young-Hoon Kim; Jung Cheol Park; Jae Sung Ahn; Jeong Hoon Kim
- Issued Date
- 2022
- Type
- Article
- Keyword
- Injury; Internal carotid artery; Management; Transsphenoidal
- DOI
- 10.1016/j.wneu.2022.03.111
- URI
- https://oak.ulsan.ac.kr/handle/2021.oak/14937
- Publisher
- World Neurosurgery
- Language
- 한국어
- ISSN
- 1878-8750
- Citation Volume
- 163
- Citation Start Page
- e230
- Citation End Page
- e237
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- Medicine > Nursing
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