Evaluation of Surgical Freedom for One-and-a-Half Nostril, Mononostril, and Binostril Endoscopic Endonasal Transsphenoidal Approaches

2020 ◽  
Author(s):  
Jin Yang ◽  
Guodao Wen ◽  
Chao Tang ◽  
Chunyu Zhong ◽  
Junhao Zhu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Carotid Artery ◽  
Internal Carotid ◽  
Attack Angle ◽  
Endoscopic Endonasal ◽  
Exposed Area ◽  
Neuronavigation System ◽  
Using Data ◽  
The One ◽  
The Right

Abstract Objective This article determines which of the one-and-a-half nostril, mononostril, and binostril endoscopic endonasal transsphenoidal approaches provide a superior manipulation during surgery. Methods The three approaches were orderly performed on 10 silicon-injected cadaveric heads to quantitatively assess surgical freedom and attack angle for sella. Measurements were determined with a standardized method under neuronavigation system using data of computed tomography. Results The one-and-a-half nostril endoscopic transsphenoidal approach (OETA) offered superior exposed area than that of the mononostril approach (META), and similar to that of the binostril approach (BETA). For surgical freedom at anatomic targets, the OETA showed greater surgical flexibility at pituitary center, the right medial optic carotid recess (R-mOCR), the left mOCR, the medial intersection of the right cavernous internal carotid artery, and extension line of upper margin of the clivus (R-mICC) than those of the META, and similar to those of the BETA.For sagittal angle of attack to the R-mOCR, R-mICC, and L-mOCR, the OETA can provide better angular freedom for surgeon than that of the META, and similar to that of the BETA. The OETA had the same axial attack to the pituitary center with the BETA. The OETA and the META had limited surgical freedom at L-mICC, and both inferior to the BETA. Conclusion The OETA has similar exposed area, surgical freedom, and attack angle for most anatomic targets to the BETA without resecting contralateral nasal septal mucosa, and obviously superior to the META.

An unexpected cause of upper airway obstruction

1995 ◽  
Vol 109 (3) ◽  
pp. 252-254 ◽  
Author(s):  
A. A. W. M. Meulenbroeks ◽  
G. D. Vos ◽  
J. M. H. Van der Beek ◽  
P. J. E. H. M. Kirslaar
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Upper Airway ◽  
Computed Tomography Scan ◽  
Parapharyngeal Abscess ◽  
The Right ◽  
Tomography Scan

AbstractA three-year old bot wiht a swelling on the right side of his neck was suspected of having parapharyngeal abscess after clinical examination and CT scan(computed tomography scan) of this region. Later it became clear, that the swelling was caused by an aneurysm of the internal carotid artery. This case report describes the pitfalls and difficulties encountered in the diagnostic course and treatment planning.

scholarly journals Pseudoaneurysm of Internal Carotid Artery following Endoscopic Endonasal Pituitary Surgery requiring Endovascular Treatment in an Acromegalic Patient with a Difficult Airway

2019 ◽  
Vol 7 (01) ◽  
pp. 34-37
Author(s):  
Joanna S. Rodrigues ◽  
Ankit Gupta ◽  
Anil Parakh
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Surgical Excision ◽  
Pituitary Surgery ◽  
Lateral Part ◽  
Team Approach ◽  
Acromegalic Patient ◽  
Endoscopic Endonasal ◽  
The Right

AbstractA pituitary tumor scheduled for surgical excision can eventuate with a myriad of challenges. A 49-year-old acromegalic patient was admitted to our hospital for trans-nasal trans-sphenoidal pituitary surgery. Magnetic resonance imaging (MRI) of his brain revealed a well-defined lesion involving right half of the anterior lobe of pituitary. In the operating room, we encountered difficulty in management of the airway. The trachea could be intubated using fiberoptic bronchoscope via a proseal laryngeal mask airway after five attempts of failed intubation. Intraoperatively, the right internal carotid artery (ICA) was injured during excision of lateral part of the tumor with a blood loss of 3.5 L. Adenosine use to aid hemostasis was unsuccessful. Endovascular coil embolization was done to treat the pseudoaneurysm developed in the right ICA, to restore the blood flow. During this process, the patient developed medial rectus palsy and ptosis in the right eye, which improved gradually. The above amalgamation of maladies commanded an integrated and well-coordinated team approach to manage the catastrophic complications.

Magnetic resonance angiography follow-up examinations to detect iatrogenic pseudoaneurysms following otorhinolaryngological surgery

2007 ◽  
Vol 121 (7) ◽  
pp. 698-701 ◽  
Author(s):  
B Buerke ◽  
B Tombach ◽  
W Stoll ◽  
W Heindel ◽  
T Niederstadt
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Endovascular Coiling ◽  
Arterial Segment ◽  
Endoscopic Endonasal ◽  
Intracranial Vessel ◽  
Vessel Injury ◽  
The Right

Endoscopic endonasal surgery on a 36-year-old man was complicated by perforation of the right internal carotid artery. The immediate, substantial haemorrhage was controlled by packing the sphenoid sinus. Intra-arterial angiography of the right internal carotid artery showed small irregularities proximal to the ophthalmic artery. A follow-up examination two weeks later documented a large pseudoaneurysm in the initially irregular arterial segment, which was successfully treated by endovascular coiling.This case report illustrates the need for angiographic follow-up examinations following traumatic intracranial vessel injury in order to identify late pseudoaneurysm development.

scholarly journals Limb-Shaking Transient Ischemic Attacks in a Patient with Previous Bilateral Neck Irradiation: The Role of Collateral Flow

2020 ◽  
Vol 12 (Suppl. 1) ◽  
pp. 84-90
Author(s):  
Chai-Hoon Nowel Tan ◽  
Manish Taneja ◽  
Narayanaswamy Venketasubramanian
Keyword(s):  
Computed Tomography ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Transient Ischemic Attacks ◽  
Hemodynamic Compromise ◽  
Neck Irradiation ◽  
Carotid Occlusive Disease ◽  
The Right ◽  
Limb Shaking

Nasopharyngeal carcinoma (NPC) is commonly treated with bilateral neck radiation, which is closely associated with the complication of carotid-occlusive disease. This leads to cerebral hemodynamic compromise and possible ischemic stroke. Another manifestation is limb-shaking transient ischemic attacks (LS-TIAs), characterized by rhythmic jerks which can be easily mistaken as a focal motor seizure. We describe a case of unilateral LS-TIAs from bilateral carotid occlusion that resolved with contralateral carotid revascularization. Our patient is a 65-year-old gentleman who had no significant co-morbidities other than a past history of bilateral neck irradiation for NPC 8 years before. He presented with left-sided limb weakness and subsequently left-sided limb involuntary movements whenever he sat up or stood. His symptoms did not respond to anti-epileptic therapy. Clinical and neurological examination was significant for a left pronator drift and weak left finger abduction. Computed tomography and magnetic resonance imaging of the brain revealed infarcts in the right periventricular and watershed areas; MR angiogram showed bilateral internal carotid artery occlusion. Single photon emission computed tomography showed reduced blood flow in the right frontal, temporal, and parietal regions, that reduced further after acetazolamide challenge. He was diagnosed as having LS-TIA secondary to carotid-occlusive disease. Attempts at endovascular opening the right internal carotid artery failed. Following successful left carotid angioplasty and stenting, his symptoms gradually resolved. The left internal carotid artery remained patent at the 3-month follow-up; the right side remained occluded. Our case supports the hypothesis that LS-TIAs are due to hemodynamic compromise and may respond to improved collateral cerebral blood flow.

Combined Endoscopic Endonasal and Contralateral Transmaxillary Approach for Petrous Cholesteatoma: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Wei-Hsin Wang ◽  
Ming-Ying Lan ◽  
Carl H Snyderman ◽  
Paul A Gardner
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Hearing Impairment ◽  
Internal Carotid ◽  
Video Recording ◽  
Internal Auditory Canal ◽  
Petrous Apex ◽  
Endoscopic Endonasal ◽  
The Right ◽  
Key Steps

Abstract This 59-yr-old man presented with headache, dizziness, diplopia, and right-side hearing impairment for years. The objective degree of hearing impairment was not available. Magnetic resonance imaging (MRI) showed a right petrous apex lesion centered behind the right petrous internal carotid artery and extending lateral to the medial aspect of the right internal auditory canal. A combined endoscopic endonasal and left contralateral transmaxillary (CTM) approach was performed, and gross-total resection was achieved. Peeling the cyst wall from the dura resulted in minor weeping. It was covered with a left-sided, vascularized nasoseptal flap. His dizziness and diplopia improved immediately after the surgery. Histopathology revealed an epidermoid cyst. In this surgical video, we demonstrate the key steps of the CTM approach for access to the petrous apex posterior to the petrous internal carotid artery (ICA).  The patient gave informed consent for surgery and video recording.

scholarly journals Morphological characteristics of the external carotid artery

2013 ◽  
Vol 19 (2) ◽  
pp. 74-78
Author(s):  
P. Gavrilidou ◽  
D.M. Iliescu ◽  
R. Baz ◽  
P. Bordei
Keyword(s):  
Carotid Artery ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Morphological Characteristics ◽  
Carotid Bifurcation ◽  
External Carotid Artery ◽  
External Carotid ◽  
The Common ◽  
The One ◽  
The Right

Abstract The morphological characteristics at the level of the bifurcation of the common carotid artery were studied on 46 cases, finding that the most frequent, in 52.17% of cases, the common carotid bifurcation appear as the letter “V”, with two possible variations: a wide “V”, in 43.48% of cases and narrow “V” in 8.7% of cases. In 30.43% of cases, the two carotids showed an ascending traject, united for 1-2 cm up to their crossing; in 13,04% of the cases the two arteries were superimposed, the external located anteriorly. In only in two cases on the right side (4.35% of cases and 8.33% of right samples) we found a peculiar aspect of a “U” shaped bifurcation. Regarding the caliber of the external carotid artery, we found that in 43.33% of the cases the external carotid artery had a similar diameter to the internal carotid, also in 43.33% of the external carotid artery have a higher caliber than internal one and the remaining 13.33% of the cases, the external carotid artery had a smaller diameter than the internal one, with all cases on the left (16.67% of left carotid arteries). The caliber of the right external carotid artery was between 4 to 5.6 mm and the one of the left was between 3.6 to 5 mm. When the external carotid was more voluminous than the internal, the differences were 0.5 to 1.2 mm and when the internal carotid was more voluminous than the external, the differences were smaller, 0.2 to 0.8 mm. In relation to the common carotid, the external carotid had a smaller caliber from 0.6 to 1.1 mm. Regarding the external carotid traject, most commonly, from the bifurcation of the common carotid, the external carotid artery showed a vertical trajectory, in 50% of cases; in 40% of cases, the traject was oblique superomedially and in 6.67% of cases the external carotid artery described a curve with the convexity facing laterally, with all cases on the right (11.76% of right carotid arteries); in 3.33% of cases, both on the left (7.69% of the left carotid arteries), the external carotid artery traject described an inverted italic “S”

Use of Adenosine to Facilitate Localization and Repair of Internal Carotid Artery Injury during Skull Base Surgery: A Case Report and Literature Review

2020 ◽  
pp. 000348942095637
Author(s):  
Obi I. Nwosu ◽  
Kolin E. Rubel ◽  
Mohamedkazim M. Alwani ◽  
Dhruv Sharma ◽  
Michael Miller ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Internal Carotid ◽  
Skull Base Surgery ◽  
Endoscopic Endonasal ◽  
Induced Hypotension ◽  
The Right ◽  
Internal Carotid Artery Injury ◽  
Neurovascular Imaging

Background: Internal carotid artery (ICA) injuries represent a rare, potentially fatal complication of endoscopic endonasal skull base surgery (EESBS). The use of adenosine to induce transient hypotension and facilitate management of high-flow, high-pressure arterial lesions has been well-documented in neuro-endovascular literature. A similar setting in which adenosine-induced hypotension may prove beneficial is during the management of major vascular injury encountered during EESBS. Methods: A case of ICA injury and subsequent repair during EESBS is presented. Results: A 74-year-old female underwent endoscopic transsphenoidal resection for a recurrent pituitary adenoma. During suprasellar resection, the right cavernous ICA was inadvertently injured resulting in brisk bleeding. Immediate vascular tamponade was applied, and a crushed muscle graft was obtained. Two intravenous doses of adenosine were administered in quick succession to produce transient hypotension and facilitate repair of the injury with the graft. Neurovascular imaging revealed a small pseudoaneurysm which remained stable throughout the postoperative course. The patient underwent definitive stent embolization of the pseudoaneurysm 1 month following discharge. Conclusion: Prompt repair of ICA injury during EESBS is crucial, but often limited by poor visualization. Adenosine-induced hypotension has demonstrated great efficacy as an adjuvant in neurovascular clipping of intracranial aneurysms and remains a valuable tool for the endoscopic skull-base surgeon as well. In cases with high risk for ICA injury, adenosine should be readily available.

scholarly journals Endovascular treatment of tandemic occlusions in acute ischemic stroke

2021 ◽  
Vol 36 (2) ◽  
pp. 73-81
Author(s):  
D.V. Shcheglov ◽  
V.N. Zahorodnii ◽  
S.V. Konotopchik ◽  
A.A. Pastushin
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Internal Carotid ◽  
Left Vertebral Artery ◽  
The Right ◽  
The Brain

The observation of endovascular treatment of acute tandem occlusion of internal carotid artery (ICA), anterior cerebral artery (ACA) and middle cerebral artery (MCA) in combination with the thrombosis of the right ICA and the critical stenosis of the left vertebral artery is presented.Man, 61 years old. He was delivered to the Center of endovascular neuroradiology, NAMS of Ukraine on January 15, 2021 with an ischemic stroke clinic in the left internal carotid artery basin. He fell ill acutely ‒ against the background of complete well-being, sensorimotor aphasia and right-sided hemiplegia appeared. Upon admission on the NIHSS (National Institutes of Health Stroke Scale) ‒ 18 points. On the performed initial multispiral computed tomography of the brain according to ASPECTS (Alberta Stroke Program Early CT score) ‒ 8 points. In the endovascular operating room, cerebral angiography was performed, followed by surgery aimed at restoring cerebral blood flow. The time from the onset of the disease to the puncture was 330 minutes, the duration of the operation was 135 minutes, thus the time from the onset of the disease to reperfusion was 465 minutes. Angiography revealed acute thrombosis of the left ICA starting from the orifice, M1-segment of the left MCA and A2-segment of the left ACA. Partial compensation of the basin through the supra-block anastomosis (external carotid artery ‒ ICA), as well as from the vertebro-basilar system through the network of leptomeningeal arteries. Collaterals ‒ ACG 3. Thrombosis of the right ICA and critical stenosis (95 %) of the V1-segment of the left vertebral artery were also revealed. The operation was performed ‒ recanalization of thrombosis of the left ICA orifice followed by balloon angioplasty, thrombectomy from the MCA and ACA pools. The end result is eTICI 2c reperfusion. There were no complications during this operation. The patient was discharged the next day (transferred to the neurological department at the place of residence). Control multispiral computed tomography of the brain showed positive dynamics (ASPECTS ‒ 1 point).

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.

Sign in / Sign up

Export Citation Format

Share Document