Basilar Artery Injury During Endonasal Surgery: Stepwise to Control Bleeding

2020 ◽  
Author(s):  
Eugenio Cárdenas Ruiz-Valdepeñas ◽  
Ariel Kaen ◽  
Jorge Tirado-Caballero ◽  
Alberto Di Somma ◽  
Miguel Iglesias Pais ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Interventional Neuroradiology ◽  
Flow Diverter ◽  
Massive Bleeding ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Muscle Graft ◽  
Artery Injury ◽  
The Right ◽  
Vessel Reconstruction

Abstract BACKGROUND Intraoperative injury during endoscopic endonasal surgery of the carotid artery has been previously described in the literature. However, the accidental damage of the basilar artery in such scenario is not defined. OBJECTIVE To define the protocol of action for massive bleeding from an artery in the posterior fossa. METHODS The reported patient was diagnosed with a partially calcified clival chordoma featured by a huge intradural component. An endoscopic endonasal transpterygoid transclival approach was selected for the treatment of this tumor. During the surgical procedure, the basilar artery injury was injured, causing intense bleeding. We present and discuss the surgical maneuvers that could save a patient's life after this dramatic complication. RESULTS Different techniques were performed in order to control the massive bleeding, including injection of hemotastic matrix with thrombin (Floseal©), bipolar coagulation, and vessel reconstruction by means of a vascular clip. Finally, an autologous muscle graft reinforced with an overlying fibrin sealant patch (Tachosil©) was chosen and was an effective technique. Afterwards, the patient was treated with a flow diverter device to occlude an iatrogenic pseudoaneurysm. A monoplegia of the right upper limb was the only remarkable sequel 6 mo after surgery. CONCLUSION The muscle graft together with the coordinated action with interventional neuroradiology for the reconstruction of the vessel are possibly the best options to try to preserve the neurological function. In such a scenario, the assumption of potential ischemic events prevails over the intraoperative death of the patient.

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.

Anatomic Nuances of the Ophthalmic Artery Origin from a Ventral Viewpoint: Considerations and Implications for Endoscopic Endonasal Surgery

2018 ◽  
Vol 16 (4) ◽  
pp. 478-485
Author(s):  
Cristian A Naudy ◽  
Juan C Yanez-Siller ◽  
Paulo M Mesquita Filho ◽  
Matias Gomez G. ◽  
Bradley A Otto ◽  
...  
Keyword(s):  
Ophthalmic Artery ◽  
Internal Carotid ◽  
Point Of View ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Nerve Segment ◽  
Surgical Field ◽  
The Right ◽  
Ophthalmic Arteries

Abstract BACKGROUND The origin of the ophthalmic artery is within the surgical field of endoscopic endonasal approaches (EEAs) to the suprasellar and parasellar regions. However, its anatomy from the endoscopic point-of-view has not been adequately elucidated. OBJECTIVE To highlight the anatomy of the ophthalmic artery origin from an endoscopic endonasal perspective. METHODS The origin of the ophthalmic artery was studied bilaterally under endoscopic visualization, after performing transplanum/transtubercular EEAs in 17 cadaveric specimens (34 arteries). Anatomic relationships relevant to surgery were evaluated. To complement the cadaveric findings, the ophthalmic artery origin was reviewed in 200 “normal” angiographic studies. RESULTS On the right side, 70.6% of ophthalmic arteries emerged from the superior aspect, while 17.6% and 11.8% emerged from the superomedial and superolateral aspects of the intradural internal carotid artery, respectively. On the left, 76.5%, 17.6%, and 5.9% of ophthalmic arteries emerged from the superior, superomedial, and superolateral aspects of the internal carotid, respectively. Similar findings were observed on angiography. All ophthalmic arteries emerged at the level of the medial opticocarotid recess. Overall, 47%, 26.5%, and 26.5% of ophthalmic arteries (right and left) were inferolateral, inferior, and inferomedial to the intracranial optic nerve segment, respectively. On both sides, the intracranial length of the ophthalmic artery ranged from 1.5 to 4.5 mm (mean: 2.90 ± standard deviation of 0.74 mm). CONCLUSION Awareness of the endoscopic nuances of the ophthalmic artery origin is paramount to minimize the risk of sight-threatening neurovascular injury during EEAs to the suprasellar and parasellar regions.

scholarly journals Management of internal carotid artery injury during endoscopic endonasal surgery

2018 ◽  
Vol 27 (3) ◽  
pp. 295-300
Author(s):  
Kazuhiko Minami ◽  
Susumu Oba ◽  
Kiyomi Kuba ◽  
Hitoshi Inoue ◽  
Yasunao Kogashiwa ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Carotid Artery Injury ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Artery Injury ◽  
Internal Carotid Artery Injury

Complications After Treatment With Pipeline Embolization for Giant Distal Intracranial Aneurysms With or Without Coil Embolization

Neurosurgery ◽  
2012 ◽  
Vol 71 (2) ◽  
pp. E509-E513 ◽  
Author(s):  
Adnan H. Siddiqui ◽  
Peter Kan ◽  
Adib A. Abla ◽  
L. Nelson Hopkins ◽  
Elad I. Levy
Keyword(s):  
Basilar Artery ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Artery Aneurysm ◽  
Mass Effect ◽  
Flow Diverter ◽  
Aneurysm Rupture ◽  
Parent Vessel ◽  
Acute Thrombosis ◽  
Vessel Reconstruction

Abstract BACKGROUND AND IMPORTANCE: The Pipeline Embolization Device (PED) is a flow diverter designed to treat intracranial aneurysms through endoluminal parent vessel reconstruction. The role of adjunctive coil embolization is unknown. CLINICAL PRESENTATION: This report details the authors' experience with the PED in 2 patients with symptomatic, giant distal intracranial aneurysms (1 basilar artery and 1 M1 segment middle cerebral artery). Both patients had successful parent vessel reconstruction. In the first patient, the basilar artery aneurysm was treated with PEDs alone, and the patient experienced early fatal brainstem hemorrhage from aneurysm rupture. In the second patient, the M1 aneurysm was treated with 2 PEDs along with dense coil embolization, with a good initial angiographic result. This patient experienced acute thrombosis of the PED post-procedure, likely related to mass effect and thrombogenicity of the dense coil mass. CONCLUSION: Flow diversion is an evolutionary step in the treatment of giant intracranial aneurysms. However, complete aneurysm occlusion occurs over a delayed period. The authors recommend placement of coils in addition to PED in the treatment of large or giant distal intracranial aneurysms in an attempt to protect the dome. However, robust packing is to be avoided because it can lead to acute PED thrombotic or compressive occlusion.

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

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.

Combined Pipeline Embolization Device with Endoscopic Endonasal Fascia Lata/Muscle Graft Repair as a Salvage Technique for Treatment of Iatrogenic Carotid Artery Injury and Pseudoaneurysm

2020 ◽  
Author(s):  
Jordina Rincon-Torroella ◽  
Ann Liu ◽  
Matthew T. Bender ◽  
Cameron G. McDougall ◽  
Anthony P. Tufaro ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Fascia Lata ◽  
Carotid Artery Injury ◽  
Endoscopic Endonasal ◽  
Pipeline Embolization Device ◽  
Muscle Graft ◽  
Artery Injury

scholarly journals Flow diverter placement for management of dissecting ruptured aneurysm in a non-fused basilar artery

2015 ◽  
Vol 22 (1) ◽  
pp. 58-61 ◽  
Author(s):  
Guillaume Saliou ◽  
Sarah Power ◽  
Timo Krings
Keyword(s):  
Basilar Artery ◽  
Vertebral Artery Dissection ◽  
Flow Diverter ◽  
Dissecting Aneurysm ◽  
Artery Dissection ◽  
Pseudoaneurysm Formation ◽  
Vertebrobasilar Junction ◽  
The Right ◽  
Flow Diverting Stent

Intracranial vertebral artery dissection can be associated with subarachnoid hemorrhage (SAH) and pseudoaneurysm formation. Dissecting aneurysms have a high risk of rebleeding in the acute phase. To our knowledge, the management of an acute vertebrobasilar junction dissecting aneurysm associated with a basilar non-fusion has not been previously reported. We report here a case of SAH due to rupture of a dissecting aneurysm involving the vertebrobasilar junction and extending to involve the right limb and proximal junction of a non-fused basilar artery, managed by insertion of a flow-diverting stent with excellent clinical outcome and long-term patency of the flow diverter.

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