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Internal Carotid Artery Injury in Transsphenoidal Surgery: Tenets for Its Avoidance and Refit-A Clinical Study
Dmitry Usachev1, Oleg Sharipov1, Ashraf Abdali1,2
1N.N. Burdenko National Medical Research Center of Neurosurgery 4-ya Tverskaya-Yamskaya 16 st., 125047 Moscow, Russia.
Brain Sciences
|January 16, 2021
Summary
Internal carotid artery (ICA) injury is a rare but serious complication of transsphenoidal surgery (TSS). This study analyzed causes, treatments, and prevention strategies for ICA injury during TSS, offering insights into surgical risk management.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Surgical Complications
Background:
- Internal carotid artery (ICA) injury is a significant risk during transsphenoidal surgery (TSS).
- Understanding the mechanisms and outcomes of ICA injury is crucial for patient safety.
Purpose of the Study:
- To analyze the etiology, treatment options, and avoidance strategies for ICA injury in patients undergoing TSS.
- To categorize angiographic collateral blood supply to guide treatment decisions for ICA injury.
Main Methods:
- Retrospective analysis of 6230 patients who underwent TSS, identifying 8 cases (0.12%) of ICA injury.
- Categorization of collateral blood supply (good, sufficient, nonsufficient) based on angiography.
- Review of surgical techniques and interventions for ICA injury.
Main Results:
- ICA injury occurred during sellar floor exposure/dural incision or tumor resection in the cavernous sinus.
- Treatment modalities included balloon occlusion, microcoils, bypass, stent grafting, and observation.
- Risk reduction is associated with improved preoperative planning, intraoperative navigation, and ultrasound dopplerography.
Conclusions:
- ICA injury during TSS is infrequent but potentially fatal.
- Management strategies should consider injury site, anatomy, and collateral circulation.
- Enhanced preoperative and intraoperative measures can minimize the risk of ICA injury.
