Endonasal surgery high-risk carotid injury timeout checklist: implementation, institutional protocol and experience

Area of Science:

• Neurosurgery
• Vascular Surgery
• Surgical Safety Protocols

Background:

• Carotid artery injury is a rare but significant complication during endonasal surgeries.
• Preparedness and a clear management plan are crucial for mitigating morbidity and mortality associated with such injuries.

Purpose of the Study:

• To examine the implementation and effectiveness of a carotid artery injury timeout checklist for high-risk endonasal procedures.
• To identify factors influencing the use of the checklist and its impact on patient outcomes.

Main Methods:

• A carotid artery injury timeout checklist was implemented for high-risk endonasal procedures, with case selection based on surgeon discretion and specific guidelines.
• Factors analyzed included tumor characteristics (Knosp grade, encasement, approach extent, size, diagnosis) and patient history (prior surgery, radiation).

Main Results:

• The checklist was used in 20.4% of 103 endonasal operations over 12 months.
• Tumor characteristics like carotid artery encasement, extended approach, and non-adenomatous diagnoses were associated with checklist use.
• A single hypertrophic vidian artery injury was successfully managed, with negligible impact on overall surgery time.

Conclusions:

• A carotid artery injury timeout checklist is feasible and beneficial for extended endonasal operations involving high-risk tumors.
• A comprehensive management plan for intraoperative and perioperative carotid artery injuries is essential for minimizing risk and ensuring timely care.