Abstract
BACKGROUNDOne of the most feared and dangerous scenarios that can appear during an endoscopic endonasal surgery (EES) is the iatrogenic injury of the internal carotid artery (ICA). Several methods, along with a variety of outcomes, have been described to deal with this complication. To the authors’ knowledge, this is the first report on the use of a Yasargil-type aneurysm clip to solve an ICA injury, preserving the artery’s patency and having a long-term follow-up. The authors discuss the advantages and disadvantages of other vessel preservation techniques compared with clipping.OBSERVATIONSA visually impaired 56-year-old woman was diagnosed with a giant nonfunctional pituitary tumor that invaded the sphenoidal sinus, anterior and posterior ethmoidal cells, and both cavernous sinuses, with suprasellar extension and optochiasmatic compression. The patient underwent EES, and during the final resection phase her left ICA was injured, with massive hemorrhage.LESSONSICA injury during endoscopic skull base surgery carries high mortality and morbidity; it is essential to maintain carotid flow when possible to avoid short-term and long-term consequences. There are several techniques depicted in the literature to deal with this situation. The authors report the use of a Yasargil mini-clip to deal with the injury for a positive outcome: primary hemostasis, vessel preservation, and no postoperative complications.
Highlights
One of the most feared and dangerous scenarios that can appear during an endoscopic endonasal surgery (EES) is the iatrogenic injury of the internal carotid artery (ICA)
In the last three decades, endoscopic skull base surgery has had important developments regarding the extension of its indications and types of approach
There is wide agreement about conducting a thorough presurgical study that includes a cranial thin-slice computed tomography (CT) scan, brain magnetic resonance imaging (MRI), and angioCT in order to comprehend the characteristics of the tumoral pathology and the surrounding vascular anatomy
Summary
One of the most feared and dangerous scenarios that can appear during an endoscopic endonasal surgery (EES) is the iatrogenic injury of the internal carotid artery (ICA). The authors report the use of a Yasargil mini-clip to deal with the injury for a positive outcome: primary hemostasis, vessel preservation, and no postoperative complications. Internal carotid artery (ICA) injury during endoscopic endonasal surgery (EES) for approaching of skull base lesions is one of the most feared and severe complications that a skull base surgeon may tackle. A variety of techniques have been described in the literature to deal with this complication; among them, vascular injury reconstruction using an aneurysm clip has been scarcely used given its technical complexity. We describe the first published case of endoscopic repair of an ICA injury using a Yasargil mini-clip (Aesculap) with ulterior preservation of vascular flow without long-term complications
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