Repair of internal carotid artery injury with aneurysm clip during endoscopic endonasal surgery: illustrative case

Abstract

BACKGROUNDOne of the most feared and dangerous scenarios that can appear during an endoscopic endonasal surgery (EES) is the iatrogenic injury of the internal carotid artery (ICA). Several methods, along with a variety of outcomes, have been described to deal with this complication. To the authors’ knowledge, this is the first report on the use of a Yasargil-type aneurysm clip to solve an ICA injury, preserving the artery’s patency and having a long-term follow-up. The authors discuss the advantages and disadvantages of other vessel preservation techniques compared with clipping.OBSERVATIONSA visually impaired 56-year-old woman was diagnosed with a giant nonfunctional pituitary tumor that invaded the sphenoidal sinus, anterior and posterior ethmoidal cells, and both cavernous sinuses, with suprasellar extension and optochiasmatic compression. The patient underwent EES, and during the final resection phase her left ICA was injured, with massive hemorrhage.LESSONSICA injury during endoscopic skull base surgery carries high mortality and morbidity; it is essential to maintain carotid flow when possible to avoid short-term and long-term consequences. There are several techniques depicted in the literature to deal with this situation. The authors report the use of a Yasargil mini-clip to deal with the injury for a positive outcome: primary hemostasis, vessel preservation, and no postoperative complications.

The surgical management of intraoperative intracranial internal carotid artery injury in open skull base surgery—a systematic review

“…The use of an aneurysm clip however has been described in endoscopic surgery to treat a punctured ICA. [11,22] Similar to its application in blister aneurysms treatment, a stenosis of the parent vessel is the most common complication. [8] Sacrifice or occlusion of the ICA: As a salvage option, if all of the above would not be possible, sacrificing the vessel either by packing (tamponade) or permanent clipping can be considered.…”

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

“…8 Meanwhile, there have also been reports of using a mini clip (Yasargil mini clip) to close leaks. 15 Despite the fact that the placement of aneurysm clips is effective, it necessitates more stringent criteria and an extended period of development.…”

“…Such operations require further exposure of the field of vision, which is a potentially laborious and time-consuming strategy 8 . Meanwhile, there have also been reports of using a mini clip (Yasargil mini clip) to close leaks 15 . Despite the fact that the placement of aneurysm clips is effective, it necessitates more stringent criteria and an extended period of development.…”