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Review
. 2022 Mar 22;8(1):54-60.
doi: 10.1002/wjo2.7. eCollection 2022 Mar.

Carotid artery injury in endoscopic endonasal surgery: Risk factors, prevention, and management

Rahul K Sharma  1   2 , Alexandria L Irace  1 , Jonathan B Overdevest  1 , David A Gudis  1
Affiliations
Review

Carotid artery injury in endoscopic endonasal surgery: Risk factors, prevention, and management

Rahul K Sharma et al. World J Otorhinolaryngol Head Neck Surg. .

Abstract

Objective: Endoscopic approaches for sinus and skull base surgery are increasing in popularity. The objective of this narrative review is to characterize risk factors for internal carotid artery injury in endoscopic endonasal surgery (EES), highlight preventative measures, and illustrate key management principles.

Data sources: Comprehensive literature review.

Methods: Relevant literature was reviewed using PubMed/MEDLINE.

Results: Carotid artery injury in EES is rare, with most studies reporting an incidence below 0.1%. Anatomic aberrancies, wide dissection margins, as well as specific provider and hospital factors, may increase the risk of injury. Multidisciplinary teams, comprehensive preoperative imaging, patient risk assessment, and formal training in vascular emergencies may reduce the risk. Management protocols should emphasize proper visualization of the injury site, fluid replacement, rapid packing, angiography, and endovascular techniques to achieve hemostasis.

Conclusions: While EES is a relatively safe procedure, carotid artery injury is a devastating complication that warrants full consideration in surgical planning. Important preventative measures include identifying patients with notable risk factors and obtaining preoperative imaging. Multidisciplinary teams and management protocols are ultimately necessary to reduce morbidity and mortality.

Keywords: carotid injury; complications; internal carotid; pituitary; pituitary adenoma; pituitary tumor; skull base surgery; surgical outcomes; transphenoidal.

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Conflict of interest statement

The authors declare no conflict of interest.

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References

    1. Alsaleh S, Manji J, Javer A. Optimization of the surgical field in endoscopic sinus surgery: an evidence‐based approach. Curr Allergy Asthma Rep. 2019;19:8. - PubMed
    1. Poetker DM, Smith TL. Adult chronic rhinosinusitis: surgical outcomes and the role of endoscopic sinus surgery. Curr Opin Otolaryngol Head Neck Surg. 2007;15:6‐9. - PubMed
    1. de Almeida JR, Su SY, Koutourousiou M, et al. Endonasal endoscopic surgery for squamous cell carcinoma of the sinonasal cavities and skull base: oncologic outcomes based on treatment strategy and tumor etiology. Head Neck. 2015;37:1163‐1169. - PubMed
    1. Higgins TS, Thorp B, Rawlings BA, Han JK. Outcome results of endoscopic vs craniofacial resection of sinonasal malignancies: a systematic review and pooled‐data analysis. Int Forum Allergy Rhinol. 2011;1:255‐261. - PubMed
    1. Kılıç S, Kılıç SS, Baredes S, et al. Comparison of endoscopic and open resection of sinonasal squamous cell carcinoma: a propensity score‐matched analysis of 652 patients. Int Forum Allergy Rhinol. 2018;8:421‐434. - PubMed