Journal of Neurological Surgery Part B: Skull Base, Inhaltsverzeichnis

J Neurol Surg B Skull Base 2024; 85(03): 241-246
DOI: 10.1055/a-2065-9404

Original Article

Endoscopic Repair of Internal Carotid Artery Injury with a Lateral Tongue Muscle Patch Graft: Novel Technique and Literature Review

Nikita Chapurin

¹Division of Rhinology/Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, United States

²Division of Rhinology/Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States

,

Rahul K. Sharma

²Division of Rhinology/Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States

,

Madelyn N. Stevens

²Division of Rhinology/Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States

,

Esther Kim

³Department of Otolaryngology, Walter Reed National Military Medical Center, Bethesda, Maryland, United States

,

Justin H. Turner

²Division of Rhinology/Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States

,

Paul T. Russell

²Division of Rhinology/Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States

› Institutsangaben

MedOne

Abstract

Objectives Iatrogenic injury to the internal carotid artery (ICA) is one of the most catastrophic complications of endoscopic sinus and skull base surgery. Previous research has shown that packing with a crushed muscle graft at the injury site can be an effective management technique to control bleeding and prevent the need for ICA sacrifice. Here, we describe a novel and readily available repair donor site—an autologous lateral tongue muscle patch.

Design Three representative cases of a successful repair of ICA injuries using a lateral tongue muscle patch are included in this study. The graft measured approximately 2 × 3 cm and was taken from the lateral intrinsic tongue musculature. We describe the harvest of the graft, its advantages, and the details of operative repair.

Results The lateral tongue provides a large and readily accessible source of muscle within the surgical field that can be quickly harvested during an endoscopic procedure. For the first case, an expanding parasellar ICA pseudoaneurysm was managed with a tongue muscle patch and nasal packing. In the second case, a cavernous ICA injury was sustained during craniopharyngioma resection. Case three involved an ICA injury during endonasal debridement of invasive fungal rhinosinusitis. None of the patients required embolization or neurovascular stenting. Postoperative angiograms and serial computed tomography angiograms showed complete resolution of the pseudoaneurysm, and the patients continued to do well at least 1 year after repair.

Conclusion Lateral tongue muscle graft is an effective and efficient method to manage ICA injuries during endoscopic endonasal surgery. Advantages include the speed of harvest, donor site being readily accessible in the surgical field, and low donor site morbidity. It should be added to the repertoire of possible donor sites for addressing catastrophic sinonasal bleeding.

Keywords

Keywords

internal carotid artery - injury - skull base surgery - muscle patch - tongue - repair - endoscopic

References
1 Halderman AA, Sindwani R, Woodard TD. Hemorrhagic complications of endoscopic sinus surgery. Otolaryngol Clin North Am 2015; 48 (05) 783-793
2 Hosemann W, Draf C. Danger points, complications and medico-legal aspects in endoscopic sinus surgery. GMS Curr Top Otorhinolaryngol Head Neck Surg 2013; 12: Doc06
3 Sharma RK, Irace AL, Overdevest JB, Gudis DA. Carotid artery injury in endoscopic endonasal surgery: risk factors, prevention, and management. World J Otorhinolaryngol Head Neck Surg 2022; 8 (01) 54-60
4 Chin OY, Ghosh R, Fang CH, Baredes S, Liu JK, Eloy JA. Internal carotid artery injury in endoscopic endonasal surgery: a systematic review. Laryngoscope 2016; 126 (03) 582-590
5 Gardner PA, Tormenti MJ, Pant H, Fernandez-Miranda JC, Snyderman CH, Horowitz MB. Carotid artery injury during endoscopic endonasal skull base surgery: incidence and outcomes. Neurosurgery 2013;73(2, Suppl Operative):ons261–ons269, discussion ons269–ons270
6 Rowan NR, Turner MT, Valappil B. et al. Injury of the carotid artery during endoscopic endonasal surgery: surveys of skull base surgeons. J Neurol Surg B Skull Base 2018; 79 (03) 302-308
7 Van Der Veken J, Mascarenhas AR, Chryssidis S, Poonoose SI. Management of an internal carotid artery injury during open skull base surgery with a crushed muscle patch—technical note and lessons learned. Oper Neurosurg (Hagerstown) 2021; 21 (05) 356-359
8 Valentine R, Wormald PJ. Carotid artery injury after endonasal surgery. Otolaryngol Clin North Am 2011; 44 (05) 1059-1079
9 Hamour AF, Laliberte F, Padhye V. et al. Development of a management protocol for internal carotid artery injury during endoscopic surgery: a modified Delphi method and single-center multidisciplinary working group. J Otolaryngol Head Neck Surg 2022; 51 (01) 30
10 Koitschev A, Simon C, Löwenheim H, Naegele T, Ernemann U. Management and outcome after internal carotid artery laceration during surgery of the paranasal sinuses. Acta Otolaryngol 2006; 126 (07) 730-738
11 Wang WH, Lieber S, Lan MY. et al. Nasopharyngeal muscle patch for the management of internal carotid artery injury in endoscopic endonasal surgery. J Neurosurg 2019; 133 (05) 1382-1387
12 Solares CA, Ong YK, Carrau RL. et al. Prevention and management of vascular injuries in endoscopic surgery of the sinonasal tract and skull base. Otolaryngol Clin North Am 2010; 43 (04) 817-825
13 Valentine R, Boase S, Jervis-Bardy J, Dones Cabral JD, Robinson S, Wormald PJ. The efficacy of hemostatic techniques in the sheep model of carotid artery injury. Int Forum Allergy Rhinol 2011; 1 (02) 118-122
14 AlQahtani A, London Jr NR, Castelnuovo P. et al. Assessment of factors associated with internal carotid injury in expanded endoscopic endonasal skull base surgery. JAMA Otolaryngol Head Neck Surg 2020; 146 (04) 364-372
15 Padhye V, Valentine R, Wormald PJ. Management of carotid artery injury in endonasal surgery. Int Arch Otorhinolaryngol 2014; 18 (Suppl 2): S173-S178
16 Kassir ZM, Gardner PA, Wang EW, Zenonos GA, Snyderman CH. Identifying best practices for managing internal carotid artery injury during endoscopic endonasal surgery by consensus of expert opinion. Am J Rhinol Allergy 2021; 35 (06) 885-894
17 Farzal Z, Lemos-Rodriguez AM, Rawal RB. et al. The reverse-flow facial artery buccinator flap for skull base reconstruction: key anatomical and technical considerations. J Neurol Surg B Skull Base 2015; 76 (06) 432-439
18 Rivera-Serrano CM, Oliver CL, Sok J. et al. Pedicled facial buccinator (FAB) flap: a new flap for reconstruction of skull base defects. Laryngoscope 2010; 120 (10) 1922-1930
19 Johnson PA, Banks P, Brown AE. Use of the posteriorly based lateral tongue flap in the repair of palatal fistulae. Int J Oral Maxillofac Surg 1992; 21 (01) 6-9
20 Lai CC, Su CY. Free mucosa graft from the lateral tongue for reconstruction of intraoral buccal/lip mucosal defects after tumor resection. Laryngoscope 2007; 117 (08) 1368-1372
21 Vaughan ED, Brown AE. The versatility of the lateral tongue flap in the reconstruction of defects of the oral cavity. Br J Oral Surg 1983; 21 (01) 1-10