Abstract
Carotid-cavernous fistula (CCF) is a rare complication after transsphenoidal surgery with only 10 cases published (Ahuja et al., 1992; Cinar et al., 2013; Cossu et al., 2020; Dolenc et al., 1999; Kalia et al., 2009; Karaman et al., 2009; Kocer et al., 2002; Koitschev et al., 2006; Pigott et al., 1989; Takahashi et al., 1969). Intraoperative findings vary from unrecognized events to life-threatening hemorrhages.We provide a description of the management of an acute CCF occurring during sphenoidotomy in a patient with pituitary apoplexy. Osteotomy performed in the rostrum resulted in a fracture, which extended toward the intracavernous carotid artery.Bleeding was managed with mechanical compression. Endovascular treatment allowed closure of the fistula through transarterial coiling and glue. Arterial patency was preserved and the patient had no new neurological deficit.Drilling should be considered over osteotomy for the anterior sphenoidotomy.The video can be found here: https://youtu.be/0Me23xIVeNI.
Highlights
Carotid-cavernous fistula (CCF) is a rare complication after transsphenoidal surgery with only 10 cases published (Ahuja et al, 1992; Cinar et al, 2013; Cossu et al, 2020; Dolenc et al, 1999; Kalia et al, 2009; Karaman et al, 2009; Kocer et al, 2002; Koitschev et al, 2006; Pigott et al, 1989; Takahashi et al, 1969)
KEYWORDS carotid-cavernous fistula; endoscopy; endovascular treatment; transsphenoidal surgery; video. This video is of a surgical complication of a hemorrhagic direct traumatic carotid-cavernous fistula occurring during endoscopic transsphenoidal surgery
0:34 Patient is a 40-year-old male with sudden-onset headache and diplopia due to a right sixth nerve palsy, who underwent an MRI, which demonstrated a hemorrhagic suprasellar mass extending into the right cavernous sinus
Summary
Carotid-cavernous fistula (CCF) is a rare complication after transsphenoidal surgery with only 10 cases published (Ahuja et al, 1992; Cinar et al, 2013; Cossu et al, 2020; Dolenc et al, 1999; Kalia et al, 2009; Karaman et al, 2009; Kocer et al, 2002; Koitschev et al, 2006; Pigott et al, 1989; Takahashi et al, 1969). KEYWORDS carotid-cavernous fistula; endoscopy; endovascular treatment; transsphenoidal surgery; video This video is of a surgical complication of a hemorrhagic direct traumatic carotid-cavernous fistula occurring during endoscopic transsphenoidal surgery.
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