J Neurol Surg B
DOI: 10.1055/s-0039-1692484
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Carotid Artery Injury during Transsphenoidal Pituitary Surgery: Lessons from a 15-Year Modern Microsurgery Cohort

1  Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
,
Avital Perry
1  Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
,
Christopher S. Graffeo
1  Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
,
Lucas P. Carlstrom
1  Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
,
Christopher R. Marcellino
1  Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
,
Anthony Burrows
1  Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
,
Irina Bancos
2  Department of Endocrinology, Mayo Clinic, Rochester, Minnesota, United States
,
Colin Driscoll
3  Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
,
Fredric B. Meyer
1  Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
› Author Affiliations
Further Information

Publication History

16 January 2019

08 May 2019

Publication Date:
24 July 2019 (online)

Abstract

Background Internal carotid artery (ICA) injury is a rare but potentially catastrophic complication of transsphenoidal resection (TSR) of pituitary tumors, potentially resulting in a host of deficits due to the risk of hemorrhage, ischemia, or even death. The endoscopic endonasal approach (EEA) has gained considerable popularity in the modern era, with few busy neurosurgeons remaining committed to practicing transnasal pituitary microsurgery. Our objective was therefore to characterize the overall incidence of ICA injury in a large, longitudinal, single-surgeon microscopic TSR series conducted during the modern EEA era.

Methods Retrospective case series.

Results Overall TSR volume by the senior author (F.B.M.) was 817 pituitary tumors during the study period, 2002 to 2017. Within that cohort, two instances of ICA injury were identified (0.2%), including one each with Cushing's disease and acromegaly, both of whom ultimately recovered without residual neurologic deficit. No pediatric injuries were identified.

Conclusion Vascular injury is an exceedingly rare complication of transsphenoidal pituitary surgery. Adjuncts to prevent this complication include careful review of the coronal magnetic resonance imaging, identification of the midline, as needed use of the Doppler, and initial caudal opening of the sellar dura. Although potentially disastrous, good neurologic outcomes may be obtained, with immediate judicious packing followed by immediate digital subtraction angiography to assess vessel patency and secondary complications such as pseudoaneurysm.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


Informed Consent

Informed consent was obtained from all individual participants included in the study.


Presentation

Components of this work were submitted as an abstract to the North American Skull Base Society, 2018.