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Emergency reconstructive endovascular management of intraoperative complications involving the internal carotid artery from trans-sphenoidal surgery
  1. Julius Griauzde1,
  2. Joseph J Gemmete2,3,4,
  3. Aditya S Pandey2,3,
  4. Erin L McKean3,4,
  5. Stephen E Sullivan3,4,
  6. Neeraj Chaudhary2,3
  1. 1Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
  2. 2Division of NeuroInterventional Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
  3. 3Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA
  4. 4Cranial Base Surgery Program, Department of Otolaryngology, University of Michigan Health System, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Joseph J Gemmete, University of Michigan Health System, Division of NeuroInterventional Radiology, Department of Radiology, UH B1 D328, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA; gemmete{at}med.umich.edu

Abstract

Purpose To report our experience with intraoperative complications involving the internal carotid artery (ICA) during trans-sphenoidal surgery and their outcome with reconstructive endovascular management.

Methods A retrospective review was conducted of patients with an ICA injury related to trans-sphenoidal surgery from 2000 to 2012. Demographic data, clinical charts, indications for treatment, radiographic images, lesion characteristics, operative notes, endovascular procedure notes and post-procedure hospital course were reviewed.

Results Three men and one woman of mean age of 52 years (range 33–74) were identified. The lesions included two macroadenomas, one meningioma and one chondrosarcoma. Risk factors for ICA rupture included two patients with carotid dehiscence, one with sphenoid septal attachment to the ICA, two with revision surgery, one with prior radiation to the tumor, one with bromocriptine treatment and two with acromegaly. In three patients, covered stent placement achieved hemostasis at the site of injury within the ICA. One patient developed delayed bleeding 6 h after covered stent placement and underwent successful endovascular occlusion of the ICA but died 6 days after the injury. The fourth patient had an intraoperative ICA stroke requiring suction thrombectomy, thrombolysis, stent placement and evacuation of an epidural hematoma. At 1-year follow-up, two patients had a modified Rankin score (mRS) and National Institute of Health Stroke Scale (NIHSS) score of 0; in the patient who had a stroke the mRS score was 1 and the NIHSS score 2.

Conclusions Endovascular management with arterial reconstruction is helpful in the treatment of ICA injuries during trans-sphenoidal surgery.

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