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CC BY-NC-ND 4.0 · J Neurol Surg Rep 2020; 81(03): e52-e58
DOI: 10.1055/s-0040-1717056
Case Report

Intracranial Intradural Vascular Injury during Endoscopic Endonasal Transsphenoidal Surgery: A Case Report and Literature Review

Mohammed Babgi 
1   Department of Surgery, Division of Neurosurgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
,
Saad Alsaleh
2   Department of Otolaryngology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
Yaser Babgi
3   Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
Saleh Baeesa 
1   Department of Surgery, Division of Neurosurgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
,
Abdulrazag Ajlan
3   Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Abstract

Background Transsphenoidal surgery (TSS) is a procedure for sellar or midline masses in the skull base. Among the reported complications are iatrogenic vascular injuries; that are rare, yet they carry devastating outcomes, with an incidence of injury between 0.34 and 2.6%. The cavernous internal carotid artery is the most commonly injured. However, intradural arterial injuries are much less reported with challenging management. We report a rare incident of intradural arterial injury during TSS, and we compared our management to the summarized few cases reported in the literature

Case Report We report a 43-year-old female who had a recurrent planum sphenoidal meningioma. She underwent trans-nasal transsphenoidal endoscopic resection that was complicated with intraoperative bleeding due to an injury to the anterior communicating artery that was challenging to control, resulted in a bilateral loss of flow in A1 segments of anterior cerebral artery and required endovascular management. The patient had a good recovery postoperatively without the typical picture of ACA syndrome.

Conclusion Intradural arterial injury is exceedingly rare in TSS, with no clear standard of care for the management. Collateral blood supply allows definitive management with minimal morbidity. Identifying the risk factors beforehand, as well as performing such cases in a well-resourced center, are crucial elements of safety.

Keywords

vascular injury - endoscopic endonasal approach - endovascular - intradural - complication


Publication History

Received: 14 February 2020

Accepted: 25 June 2020

Article published online:
24 September 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Stuttgart · New York

 

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