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. 2020 Apr 1;2(2):V1.
doi: 10.3171/2020.4.FocusVid.19918. eCollection 2020 Apr.

Hemorrhagic direct traumatic carotid-cavernous fistula during endoscopic transsphenoidal surgery: intraoperative management and endovascular treatment

Giulia Cossu  1 , Tyler Atkins  1 , Steven D Hajdu  2 , Francesco Puccinelli  2 , Roy T Daniel  1 , Mahmoud Messerer  1
Affiliations

Hemorrhagic direct traumatic carotid-cavernous fistula during endoscopic transsphenoidal surgery: intraoperative management and endovascular treatment

Giulia Cossu et al. Neurosurg Focus Video. .

Abstract

Carotid-cavernous fistula (CCF) is a rare complication after transsphenoidal surgery with only 10 cases published (Ahuja et al., 1992; Cinar et al., 2013; Cossu et al., 2020; Dolenc et al., 1999; Kalia et al., 2009; Karaman et al., 2009; Kocer et al., 2002; Koitschev et al., 2006; Pigott et al., 1989; Takahashi et al., 1969). Intraoperative findings vary from unrecognized events to life-threatening hemorrhages. We provide a description of the management of an acute CCF occurring during sphenoidotomy in a patient with pituitary apoplexy. Osteotomy performed in the rostrum resulted in a fracture, which extended toward the intracavernous carotid artery. Bleeding was managed with mechanical compression. Endovascular treatment allowed closure of the fistula through transarterial coiling and glue. Arterial patency was preserved and the patient had no new neurological deficit. Drilling should be considered over osteotomy for the anterior sphenoidotomy. The video can be found here: https://youtu.be/0Me23xIVeNI.

Keywords: carotid-cavernous fistula; endoscopy; endovascular treatment; transsphenoidal surgery; video.

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Conflict of interest statement

Disclosures The author reports no conflict of interest concerning the materials or methods used in this study or the findings specified in this article.

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