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Internal Carotid Artery Injury During Endoscopic Endonasal Surgery for Skull Base Pathologies: An Institutional Incidence, Management, and Outcome Publisher Pubmed



Iranmehr A1 ; Sarpoolaki MK1 ; Sadrehosseini SM2 ; Tabari A2 ; Zeinalizadeh M1
Authors
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Authors Affiliations
  1. 1. Neurosurgery Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Rhinology and Skull Base Surgery, Otolaryngology Head Neck Surgery Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

Source: ANZ Journal of Surgery Published:2023


Abstract

Background: Endoscopic endonasal surgery (EES) has become a popular approach to deal with skull base pathologies. The most catastrophic intra-operative complication of EES is internal carotid artery (ICA) injury. We aim to discuss and introduce our institutional experience with ICA injury during EES. Methods: A retrospective review of patients who underwent EES from 2013 to 2022 was performed to determine the incidence and outcomes of intraoperative ICA injuries. Results: There were six patients (0.56%) with intraoperative ICA injury in our institution during the last 10 years. Fortunately, there was no morbidity or mortality in our patients with intraoperative ICA injuries. The sites of injury were equally in paraclival, cavernous sinus, and preclinoidal segments of ICA. Conclusion: Primary prevention is the best solution for this condition. Regarding our institutional experience, the best option for primary management just after an injury is packing the surgical site. In cases where packing is not enough for temporary control of bleeding, common carotid artery occlusion should be considered. We have presented our experience and reviewed previous studies regarding different treatments and suggested our intra and post-operative management algorithm. © 2023 Royal Australasian College of Surgeons.