Internal Carotid Injury during Skull Base Surgery—Case Report and a Review of the Literature

Abstract

Iatrogenic injury of the internal carotid artery (ICA) is a rare, and probably underreported, complication of transnasal endoscopic skull base surgery. Although treatment algorithms have been suggested, there is no definite consensus or guideline for the management of this severe complication. We describe a case of ICA injury that occurred during a transsphenoidal biopsy of a tumor in the cavernous sinus and we present a treatment algorithm for managing this complication. We reviewed the articles published from 1998 to 2021, reporting on major vascular injury during transnasal endoscopic skull base surgery and endonasal endoscopic surgery, and we compare the methods and results of ICA injury management reported in the literature with the presented case. The most promising treatment for ICA injury might be packing with a muscle graft initially, then performing an endovascular intervention.

Report on Pseudoaneurysm Caused by Injury of Internal Carotid Artery During Endoscopic Pituitary Surgery and Rebleeding After Treatment With Willis Covered Stent

“…6 In the face of ICA injury during EES, the current consensus is that multidisciplinary cooperation is needed, including anesthesia, otorhinolaryngology, neurointervention, transfusion, ICU, rehabilitation, etc. [7][8][9] The surgeon needs to perform emergency hemostasis to reduce bleeding. At this juncture, time is of the essence, and blood equates to life.…”

“…Meanwhile, type III injury was the most frequently documented in EES and was associated with unfavorable outcomes 6 . In the face of ICA injury during EES, the current consensus is that multidisciplinary cooperation is needed, including anesthesia, otorhinolaryngology, neurointervention, transfusion, ICU, rehabilitation, etc 7–9 …”