Cavernous carotid pseudoaneurysm following transsphenoidal surgery

Area of Science:

• Neurosurgery
• Vascular Surgery
• Endovascular Therapy

Background:

• Transsphenoidal surgery, a common procedure for pituitary tumors, carries a risk of rare but severe internal carotid artery (ICA) injury.
• Iatrogenic pseudoaneurysms of the ICA are a significant complication, necessitating careful diagnosis and management.

Observation:

• A review of 22 literature cases and one novel case of ICA pseudoaneurysm post-transsphenoidal surgery was conducted.
• A significant percentage (23%) of patients presented with pseudoaneurysms without intraoperative evidence of vascular injury or hemorrhage.
• Epistaxis was the most frequent initial symptom (41%), with diagnosis often confirmed by traditional angiography.

Findings:

• Patients presented with pseudoaneurysms an average of 83 days post-surgery, or 64 days if intraoperative bleeding was noted.
• While intraoperative bleeding is a strong predictor, postoperative bruits may also indicate pseudoaneurysm formation.
• Complete ICA occlusion was required in 41% of cases, with other treatments employed for the remainder.

Implications:

• Early recognition of ICA pseudoaneurysms, even without intraoperative bleeding, is crucial for timely intervention.
• The findings underscore the importance of considering alternative diagnostic signs like postoperative bruits.
• Further case accumulation is needed to establish definitive recommendations for management, including the evolving role of endovascular techniques.