Salvage management and subsequent treatment after internal carotid artery injury during transnasal endoscopic surgery
10.3760/cma.j.issn.1673-0860.2012.07.007
- VernacularTitle:经鼻内镜手术颈内动脉损伤的紧急处理与接续治疗
- Author:
Ke-Jun ZUO
1
;
Rui XU
;
Yin-Yan LAI
;
Zhan-Quan YANG
;
Qiu-Hang ZHANG
;
Geng XU
Author Information
1. 中山大学附属第一医院
- Keywords:
Endoscopy;
Otorhinolaryngologic surgical procedures;
Sella turcica;
Carotid artery,internal;
Intraoperative complications
- From:
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
2012;47(7):554-558
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the cause,urgent management,further treatment,outcome and prevention of internal carotid artery (ICA) injury during transnasal endoscopic surgery.Methods Five ICA injury happened during transnasal endoscopic surgery of sphenoidal sinus and (or) sellar region,involving 1 case of traumatic optic neuropathy,1 case of sphenoidal cyst,1 case of fungal sphenoid sinusitis,1 case of sellar adenoid cystic carcinoma and 1 case of pituitary tumor.These five cases were from three different hospitals in 1990 -2009,and the clinical data were collected and retrospectively reviewed.Results Injury of ICA was related with improper anatomic localization and operative procedures.The locations of injury were in cavenous segement in 3 cases,lacerum segment in 1 case,and clinic segment in 1 case,respectively.The types of injury included 3 cases of bleeding of laceration,1 case of carotid cavernous fistula and 1 case of pseudoaneurysme.Salvage sphenoid sinus packing with vaseline strip and subsequent intravascular stent graft implantation (2 cases) and endovascular embolization (2 cases) effectively controlled bleeding.Four cases were successfully treated without craniocerebral or ocular complications,only 1 case died of massive blood loss.Among 4 survival cases,1 patient abandoned further therapy,the other 3 patients were curcd of primary disease by reoperation or subsequent treatment.Conclusion Preoperatively,reading carefully the imaging data,intraoperatively,identifying anatomical positions accurately,performing proper operation,and stopping bleeding decidedly, postoperatively, seeking interdisciplinary cooperation to repair vascular damages,all these procedures can effectively reduce the surgical risk of ICA injury.
