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Management of Internal Carotid Artery Injury During Transsphenoidal Surgery: A Case Series and Suggestion for Optimal Management

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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 HongJoonho ByunWonhyoung ParkYoung-Hoon KimJung Cheol ParkJae Sung AhnJeong Hoon Kim
Issued Date
2022
Type
Article
Keyword
InjuryInternal carotid arteryManagementTranssphenoidal
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
Appears in Collections:
Medicine > Nursing
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