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CC BY-NC-ND 4.0 · J Neurol Surg Rep 2021; 82(04): e53-e62
DOI: 10.1055/s-0041-1740511
Original Article

Carotid Artery-Cavernous Segment Injury during an Endoscopic Endonasal Surgery: A Case Report and Literature Review of the Overlooked Option for Surgical Trapping in the Hyperacute Phase

Autoren

  • Gokmen Kahilogullari 

    1   Department of Neurosurgery, Ankara University, Ankara, Turkey

  • Burak Bahadır 

    1   Department of Neurosurgery, Ankara University, Ankara, Turkey

  • Melih Bozkurt 

    1   Department of Neurosurgery, Ankara University, Ankara, Turkey

  • Seray Akcalar 

    2   Department of Radiology, Ankara University, Ankara, Turkey

  • Sinan Balci 

    3   Department of Radiology, Hacettepe University, Ankara, Turkey

  • Anil Arat 

    3   Department of Radiology, Hacettepe University, Ankara, Turkey

Funding None.
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Abstract

Internal carotid artery (ICA) injury is a catastrophic complication of endoscopic endonasal surgery (EES). However, its standard management, emergent endovascular treatment, may not always be available, and the transnasal approach may be insufficient to achieve hemostasis.

A 44-year-old woman with pituitary adenoma underwent EES complicated with the ICA cavernous segment injury (CSI). In urgent intraoperative angiogram, a good collateral flow from the contralateral carotid circulation was observed. Due to the unavailability of intraoperative embolization, emergent surgical trapping was performed by combined transcranial and cervical approach. The patient recovered but later developed a giant cavernous pseudoaneurysm. During the pseudoaneurysm embolization, ICA was directly accessed via a 1.7-F puncture hole using a bare microcatheter technique. Then, both the aneurysm and parent artery were obliterated with coils. At the 4-year follow-up, the patient was asymptomatic without a residual tumor. To our knowledge, this is the first case of ICA–CSI during EES successfully treated with ICA trapping as a lifesaving urgent surgery that achieved a complete recovery after a pseudoaneurysm embolization. Although several studies reported that EES-related ICA–CSIs with percutaneous carotid artery access, neither our surgical salvage technique nor our carotid access and tract embolization techniques were previously described.

Keywords

endonasal endoscopic surgery - endovascular treatment - ICA-cavernous segment - pituitary adenoma - trapping - urgent transcranial surgery

Supplementary Material



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Eingereicht: 14. Mai 2021

Angenommen: 20. September 2021

Artikel online veröffentlicht:
14. Dezember 2021

© 2021. 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/)

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