Management of an Internal Carotid Artery Injury During Open Skull Base Surgery With a Crushed Muscle Patch – Technical Note and Lessons Learned

2021 ◽  
Author(s):  
Jorn Van Der Veken ◽  
Annika Reann Mascarenhas ◽  
Steve Chryssidis ◽  
Santosh Isaac Poonoose
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Internal Carotid ◽  
Skull Base Surgery ◽  
Technical Note ◽  
Lessons Learned ◽  
Parent Vessel ◽  
Lack Of Information ◽  
Planum Sphenoidale

Abstract BACKGROUND Iatrogenic internal carotid artery (ICA) injury is a catastrophic complication in open skull base surgery. There is a lack of information regarding the most appropriate techniques on how to manage this complication. OBJECTIVE To highlight the difficulties encountered when an ICA injury arises intraoperatively and discuss the role and the potential pitfalls of the crushed muscle patch in the management of an ICA injury during open skull base surgery. METHODS In this technical video, we demonstrate the management of intraoperative ICA injury, which occurred during the resection of a diffuse planum sphenoidale meningioma via a left pterional craniotomy. RESULTS When isolation of the defect with temporary clips failed, we opted for a crushed muscle graft to plug the defect. Hemostasis was achieved, but because of prolonged pressure application and “overpacking,” the parent vessel was occluded. CONCLUSION The crushed muscle patch can be easily applied; however, care must be taken not to “overpack” and occlude the ICA.

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 P14.10 Endoscopic skull base surgery for tumors invading internal carotid artery

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii68-iii68
Author(s):  
S Geng
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Multimodal Imaging ◽  
Internal Carotid ◽  
Skull Base Surgery ◽  
3 Dimensional ◽  
Endoscopic Skull Base Surgery ◽  
Vascular Structures ◽  
The Relationship

Abstract BACKGROUND Internal carotid artery (ICA) injury is a disaster in endoscopic skull base surgery, so protection of internal carotid artery is an essential task. We use 3-dimensional multimodal imaging (3D-MMI) and intraoperative navigation (ION) in endoscopic skull base surgery to locate ICA and decrease ICA injury. MATERIAL AND METHODS 26 patients underwent endoscopic skull base surgery (pituitary adenomas, chordomas, neurinomas and other tumors invading internal carotid artery) guided by 3D-MMI and ION techniques to locate ICA. RESULTS In all patients, the 3D-MMI and ION techniques enabled adequate visualization of vascular structures stereoscopically, especially the relationship between lesion and ICA, and suplly real-time navigation to locate ICA during endoscopic skull base surgery. No ICA injury happened and neurosurgeons removed tumors with relaxed mind. CONCLUSION 3D-MMI and ION techniques were found to be helpful to locate internal carotid artery and decrease ICA injury during endoscopic skull base surgery.

The Carotid Artery

1995 ◽  
Vol 112 (5) ◽  
pp. P84-P84
Author(s):  
Bruce W. Pearson ◽  
Robert H. Wharen
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Internal Carotid ◽  
Skull Base Surgery ◽  
Educational Objectives

Educational objectives: To better understand the preoperative and intraoperative risk to the internal carotid artery in neck and skull base surgery and to work more closely and knowledgeably with their neurovascular surgical colleagues in combined cases.

Surgical Exposure of the Petrous Internal Carotid Artery: Practical Application for Skull Base Surgery

1997 ◽  
Vol 107 (7) ◽  
pp. 967-976 ◽  
Author(s):  
Leigh Anne Dew ◽  
Clough Shelton ◽  
H. Ric Harnsberger ◽  
B. Gregory Thompson
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Internal Carotid ◽  
Skull Base Surgery ◽  
Practical Application ◽  
Surgical Exposure

Eustachian tube and internal carotid artery in skull base surgery: An anatomical study

2014 ◽  
Vol 124 (12) ◽  
pp. 2655-2664 ◽  
Author(s):  
Jianfeng Liu ◽  
Carlos D. Pinheiro-Neto ◽  
Juan C. Fernandez-Miranda ◽  
Carl H. Snyderman ◽  
Paul A. Gardner ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Eustachian Tube ◽  
Internal Carotid ◽  
Skull Base Surgery ◽  
Anatomical Study

scholarly journals Endoscopic Endonasal Repair of Internal Carotid Artery Injury during Endoscopic Endonasal Surgery

2017 ◽  
Vol 78 (04) ◽  
pp. e125-e128 ◽  
Author(s):  
Irit Duek ◽  
Gill Sviri ◽  
Moran Amit ◽  
Ziv Gil
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Internal Carotid ◽  
Skull Base Surgery ◽  
Endoscopic Management ◽  
Carotid Artery Injury ◽  
Endoscopic Endonasal ◽  
Artery Injury ◽  
Endoscopic Skull Base Surgery

Background Injury to the cavernous portion of the internal carotid artery (ICA) during endoscopic skull base surgery is a well-recognized rare complication that can be associated with high rates of morbidity and mortality. Many techniques have been suggested to manage ICA injury with varying degrees of success. Objectives We provide a detailed technical description of an operative technique for endoscopic management of carotid artery injury. Methods A case of ICA injury during endoscopic skull base surgery is presented. The immediate treatment measurements include: (1) early recognition of ICA injury, (2) briefing of the team and preparations, (3) packing, (4) harvesting of temporalis muscle patch, (5) placement of the muscle patch over the defect, and (6) gentle compression for 10 minutes. Results The technique facilitates quick repair and restores normal blood flow through the damaged artery. Exsanguination or the symptoms of stroke that may occur from prolonged occlusion of the ICA are therefore prevented. Conclusion The proposed protocol is useful for the management of a potentially life-threatening ICA injury.

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