Int Arch Otorhinolaryngol 2014; 18(S 02): S173-S178
DOI: 10.1055/s-0034-1395266
Review Article
Thieme Publicações Ltda Rio de Janeiro, Brazil

Management of Carotid Artery Injury in Endonasal Surgery

Vikram Padhye
1  Department of Surgery - Otolaryngology, Head & Neck Surgery, The University of Adelaide, South Australia, Australia
,
Rowan Valentine
1  Department of Surgery - Otolaryngology, Head & Neck Surgery, The University of Adelaide, South Australia, Australia
,
Peter-John Wormald
1  Department of Surgery - Otolaryngology, Head & Neck Surgery, The University of Adelaide, South Australia, Australia
› Author Affiliations
Further Information

Publication History

Publication Date:
10 October 2014 (online)

  

Abstract

Introduction Carotid artery injury (CAI) is the most feared and potentially catastrophic intraoperative complication an endoscopic skull base surgeon may face. With the advancement of transnasal endoscopic surgery and the willingness to tackle more diverse pathology, evidence-based management of this life-threatening complication is paramount for patient safety and surgeon confidence.

Objectives We review the current English literature surrounding the management of CAI during endoscopic transnasal surgery.

Data Synthesis The searched databases included PubMed, MEDLINE, Cochrane database, LILACS, and BIREME. Keywords included “sinus surgery,” “carotid injury,” “endoscopic skull base surgery,” “hemostasis,” “transsphenoidal” and “pseudoaneurysm.”

Conclusions Review of the literature found the incidence of CAI in endonasal skull base surgery to be as high as 9% in some surgeries. Furthermore, current treatment recommendations can result in damage to critical neurovascular structures. Management decisions must be made in the preoperative, operative, and postoperative setting to ensure adequate treatment of CAI and the prevention of its complications such as pseudoaneurysm. Emphasis should be placed on surgical competency, teamwork, and technical expertise through education and training.

Final Comments

Prevention and management of carotid artery injury is a combination of appropriate patient selection, surgical competency, and teamwork, culminating in the formulation and execution of a surgical plan. In this anxiety-provoking situation, the need for appropriate training cannot be underestimated. In addition to clinical training, targeted vascular workshops utilizing cadaveric and live animal specimens will help surgeons acquire technical expertise as well as skills in teamwork and plan formulation necessary to gain the most favorable outcome for the patient.