Ahead of Print: Carotid Artery Injury in Endonasal Skull Base Surgery

Carotid_Artery_Injury_During_Endoscopic_EndonasalBackground: Injury to the internal carotid artery (ICA) during endoscopic endonasal skull base surgery (ESBS) is a feared complication that is not well studied or reported.

Objective: To evaluate the incidence, identify potential risk factors, and present management strategies and outcomes of ICA injury during ESBS at our institution.

Methods: We performed a retrospective review of all endoscopic endonasal operations performed at our institution between 1998-2011 to examine potential factors predisposing to ICA injury. We also document the perioperative management and outcomes following injury.

Results: There were 7 ICA injuries encountered in 2015 ESBSs, giving an incidence of 0.3%. Most injuries (5/7) involved the left ICA and the most common diagnosis was chondroid neoplasm (chordoma, chondrosarcoma; 3/7 (2% of 142 cases)). There were 2/660 injuries during pituitary adenoma resection (0.3%). The paraclival ICA segment was the most commonly injured site (5/7) and transclival and transpterygoid approaches had a higher incidence of injury, though neither factor reached statistical significance. 4/7 injured ICAs were sacrificed, either intra- or postoperatively. No patient suffered a stroke or neurologic deficit. There were no intraoperative mortalities; one patient died postoperatively due to cardiac ischemia. One of the 3 preserved ICAs developed a pseudoaneurysm over a mean follow-up period of 5 months, which was treated endovascularly.

Conclusion: ICA injury during ESBS is an infrequent and manageable complication. Preservation of the vessel remains difficult. Chondroid tumors represent a higher risk and should be resected by surgical teams with significant experience.

From: Carotid Artery Injury During Endoscopic Endonasal Skull Base Surgery: Incidence and Outcomes by Gardner et al.

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