scholarly journals Carotid Artery-Cavernous Segment Injury during an Endoscopic Endonasal Surgery: A Case Report and Literature Review of the Overlooked Option for Surgical Trapping in the Hyperacute Phase

2021 ◽  
Vol 82 (04) ◽  
pp. e53-e62
Author(s):  
Gokmen Kahilogullari ◽  
Burak Bahadır ◽  
Melih Bozkurt ◽  
Seray Akcalar ◽  
Sinan Balci ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Residual Tumor ◽  
Complete Recovery ◽  
Parent Artery ◽  
Collateral Flow ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Transnasal Approach ◽  
Endoscopic Endonasal ◽  
First Case

AbstractInternal carotid artery (ICA) injury is a catastrophic complication of endoscopic endonasal surgery (EES). However, its standard management, emergent endovascular treatment, may not always be available, and the transnasal approach may be insufficient to achieve hemostasis.A 44-year-old woman with pituitary adenoma underwent EES complicated with the ICA cavernous segment injury (CSI). In urgent intraoperative angiogram, a good collateral flow from the contralateral carotid circulation was observed. Due to the unavailability of intraoperative embolization, emergent surgical trapping was performed by combined transcranial and cervical approach. The patient recovered but later developed a giant cavernous pseudoaneurysm. During the pseudoaneurysm embolization, ICA was directly accessed via a 1.7-F puncture hole using a bare microcatheter technique. Then, both the aneurysm and parent artery were obliterated with coils. At the 4-year follow-up, the patient was asymptomatic without a residual tumor. To our knowledge, this is the first case of ICA–CSI during EES successfully treated with ICA trapping as a lifesaving urgent surgery that achieved a complete recovery after a pseudoaneurysm embolization. Although several studies reported that EES-related ICA–CSIs with percutaneous carotid artery access, neither our surgical salvage technique nor our carotid access and tract embolization techniques were previously described.

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.

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.

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

Intraoperative Protocol for the Management of Carotid Artery Injury during Endoscopic Endonasal Surgery

2020 ◽  
Author(s):  
Zachary Kassir ◽  
Carl H. Snyderman ◽  
Paul A. Gardner ◽  
Eric W. Wang ◽  
Georgios A. Zenonos
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Injury ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Artery Injury

scholarly journals Iatrogenic seeding of skull base chordoma following endoscopic endonasal surgery

2018 ◽  
Vol 129 (4) ◽  
pp. 947-953 ◽  
Author(s):  
David T. Fernandes Cabral ◽  
Georgios A. Zenonos ◽  
Juan C. Fernandez-Miranda ◽  
Eric W. Wang ◽  
Paul A. Gardner
Keyword(s):  
Subcutaneous Tissue ◽  
Inferior Turbinate ◽  
Petrous Apex ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Ki 67 ◽  
Endoscopic Endonasal ◽  
Tumor Seeding ◽  
Clival Chordoma ◽  
First Case

OBJECTIVEIatrogenic tumor seeding after open surgery for chordoma has been well described in the literature. The incidence and particularities related to endoscopic endonasal surgery (EES) have not been defined.METHODSThe authors retrospectively reviewed their experience with EES for clival chordoma, focusing on cases with iatrogenic seeding. The clinical, radiographic, pathological, and molecular characterization data were reviewed.RESULTSAmong 173 EESs performed for clival chordomas at the authors’ institution between April 2003 and May 2016, 2 cases complicated by iatrogenic seeding (incidence 1.15%) were identified. The first case was a 10-year-old boy, who presented 21 months after an EES for a multiply recurrent clival chordoma with a recurrence along the left inferior turbinate, distinct from a right petrous apex recurrence. Both appeared as a T2-hypertintense, T1-isointense, and heterogeneously enhancing lesion on MRI. Resection of the inferior turbinate recurrence and debulking of the petrous recurrence were both performed via a purely endoscopic endonasal approach. Unfortunately, the child died 2 years later due progression of disease at the primary site, but with no sign of progression at the seeded site. The second patient was a 79-year-old man with an MRI-incompatible pacemaker who presented 19 months after EES for his clival chordoma with a mass involving the floor of the left nasal cavity that was causing an oro-antral fistula. On CT imaging, this appeared as a homogeneously contrast-enhancing mass eroding the hard palate inferiorly, the nasal septum superiorly, and the nasal process of the maxilla, with extension into the subcutaneous tissue. This was also treated endoscopically (combined transnasal-transoral approach) with resection of the mass, and repair of the fistula by using a palatal and left lateral wall rotational flap. Adjuvant hypofractionated stereotactic CyberKnife radiotherapy was administered using 35 Gy in 5 fractions. No recurrence was appreciated endoscopically or on imaging at the patient’s last follow-up, 12 months after this last procedure. In both cases, pathological investigation of the original tumors revealed a fairly aggressive biology with 1p36 deletions, and high Ki-67 levels (10%–15%, and > 20%, respectively). The procedures were performed by a team of right-handed surgeons (otolaryngology and neurosurgery), using a 4-handed technique (in which the endoscope and suction are typically passed through the right nostril, and other instruments are passed through the left nostril without visualization).CONCLUSIONSAlthough uncommon, iatrogenic seeding occurs during EES for clival chordomas, probably because of decreased visualization during tumor removal combined with mucosal trauma and exposure of subepithelial elements (either inadvertently or because of mucosal flaps). In addition, tumors with more aggressive biology (1p36 deletions, elevated Ki-67, or both) are probably at a higher risk and require increased vigilance on surveillance imaging and endoscopy. Further prospective studies are warranted to evaluate the authors’ proposed strategies for decreasing the incidence of iatrogenic seeding after EES for chordomas.

Intraoperative Protocol for the Management of Carotid Artery Injury during Endoscopic Endonasal Surgery

2021 ◽  
Author(s):  
Zachary M. Kassir ◽  
Eric W. Wang ◽  
Georgios A. Zenonos ◽  
Paul A. Gardner ◽  
Carl H. Snyderman
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Injury ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Artery Injury

scholarly journals Injury of the Carotid Artery during Endoscopic Endonasal Surgery: Surveys of Skull Base Surgeons

2017 ◽  
Vol 79 (03) ◽  
pp. 302-308 ◽  
Author(s):  
Nicholas Rowan ◽  
Meghan Turner ◽  
Benita Valappil ◽  
Juan Fernandez-Miranda ◽  
Eric Wang ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Skull Base ◽  
High Morbidity ◽  
Carotid Artery Injury ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Artery Injury ◽  
Surgeon Experience ◽  
Carotid Artery Injuries

Objectives This study aimed to review endoscopic skull base surgeon experience with internal carotid artery (ICA) injuries during endoscopic endonasal surgery (EES) to provide an estimate of the incidence of ICA injury, the associated factors and identify the best training modalities for the management of this complication. Design Anonymous electronic survey of past participants at a well-established endoscopic skull base surgery course and a global online community of skull base surgeons. Main Outcome Measures Relative incidence of ICA injuries during EES, associated anatomic and intraoperative factors, and surgeon experience. Results At least 20% of surgeons in each surveyed population experienced a carotid artery injury. Reported carotid artery injuries were most common during tumor exposure and removal (48%). The parasellar carotid artery was the most commonly injured segment (39%). Carotid artery injuries were more common in high-volume surgeons, but only statistically significant in one of the two populations. Attendance at a skull base course or courses did not change the incidence of carotid artery injury in either surveyed population. In both surveys, respondents preferred live surgeries or active (not computer simulated) training models. Conclusions ICA injury is underreported and most common when manipulating the parasellar carotid artery for exposure and tumor dissection. Given the high morbidity and mortality associated with these injuries, vascular injury management should be prioritized and taught in a graduated approach by modern endoscopic skull base courses.

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.

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