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Management of an Internal Carotid Artery Injury During Open Skull Base Surgery With a Crushed Muscle Patch -
Jorn Van Der Veken1, Annika Reann Mascarenhas1, Steve Chryssidis2
1Neurosurgery Department, Flinders Medical Centre, Bedford Park, Australia.
Operative Neurosurgery (Hagerstown, Md.)
|August 1, 2021
Summary
Managing internal carotid artery (ICA) injury during skull base surgery requires caution. A crushed muscle patch can achieve hemostasis but risks vessel occlusion if overpacked.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Surgical Complications
Background:
- Iatrogenic internal carotid artery (ICA) injury is a severe complication in open skull base surgery.
- Current literature lacks comprehensive guidance on managing intraoperative ICA injuries.
Purpose of the Study:
- To illustrate the challenges of intraoperative ICA injury during skull base surgery.
- To evaluate the efficacy and potential risks of using a crushed muscle patch for ICA injury management.
Main Methods:
- Demonstration of intraoperative internal carotid artery injury management.
- Technique involves resection of a planum sphenoidale meningioma via pterional craniotomy.
- Utilized a crushed muscle graft after temporary clipping failure.
Main Results:
- Hemostasis was achieved using a crushed muscle graft.
- Prolonged pressure and overpacking led to parent vessel occlusion.
- The technique highlights the delicate balance required for effective hemostasis.
Conclusions:
- Crushed muscle patches offer a feasible method for managing ICA injuries.
- Crucial to avoid overpacking to prevent internal carotid artery occlusion.
- Careful application is essential to prevent catastrophic vessel compromise.
