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. 2023 Jul-Aug;93(7-8):1964-1969.
doi: 10.1111/ans.18541. Epub 2023 May 24.

Internal carotid artery injury during endoscopic endonasal surgery for skull base pathologies: an institutional incidence, management, and outcome

Arad Iranmehr  1 , Mohammad Kazem Sarpoolaki  1 , Seyed Mousa Sadrehosseini  2 , Azin Tabari  2 , Mehdi Zeinalizadeh  1
Affiliations

Internal carotid artery injury during endoscopic endonasal surgery for skull base pathologies: an institutional incidence, management, and outcome

Arad Iranmehr et al. ANZ J Surg. 2023 Jul-Aug.

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.

Keywords: carotid injury; endonasal surgery; endoscopic surgery.

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References

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