Vascular repair for iatrogenic injury during microsurgical procedures: Clinical investigation and review of 18 cases at a single institution.

Abstract

Intracranial vascular injury (VI) due to surgery is a critical complication that can lead to serious neurological deficits. To our knowledge, only a few review articles on VI during an operation have been published. We retrospectively investigated the type, cause, and measurement of VI during surgery at our institution. Unexpected VI cases occurred in 18 of 2228 craniotomy procedures, including 794 clippings and 357 tumour resections. We investigated the causes and coping techniques of the VI cases, as well as their full details. There were six cases of aneurysm neck tear, one case of sylvian vein injury, and one case of superior trunk perforation during direct clipping. Regarding tumour resection procedures, nine cases of arterial injury and one case of cortical vein injury were extracted. Almost all VIs were caused by carelessness or basic manipulation mistakes. We repaired all these cases with simple placement of suture threads with or without pinch clips, flow alteration using bypass techniques, and in 16 cases no neurological deficit or imaging exacerbation occurred; however, three patients were verified to have ischaemic changes on postoperative imaging. Most VIs were directly caused by a simple error and carelessness of an operator or assistant. Many of these injuries can be avoided if surgical procedures obey and remember a basic set of rules. However, the surgical procedure involves human work, and errors cannot be eradicated even upon maximum concentration levels. Neurosurgeons should arrange preparations for an eventual quick repair of unexpected cerebral VIs.