Verletzung der ACI bei Nasennebenhöhlenoperation und Management durch endovaskuläre Stentapplikation

Abstract

Injury of the internal carotid artery (ICA) during endonasal sinus surgery is rare but a life-threatening situation for the patient. For adequate treatment endovascular therapy as embolization or balloon occlusion is usually performed although there is a high risk of irreversible neurological deficits. We report on a twenty-five-year-old female patient with acute exacerbated chronic polyposis nasi suffering from an injury of the ICA during endonasal sinus surgery. After intraoperative identification of the site of hemorrhage the massive bleeding could temporarily be controlled by a nasal pack. The woman was immediately transferred to a neuroradiological department. After angiographic localization of the vessel defect the bleeding could be stopped by application of a vascular stent without any neurological deficits during or after the procedure. Anatomical characteristics of the ICA in the sphenoid sinus, and recommended emergency treatment and preventive measures are discussed. Although vascular stents are difficult to place in the intrasphenoidal course of the ICA, it provides an effective closure of the vascular injury and above all a sufficient cerebral perfusion, therefore, the risk of neurological defects can be reduced.