Introduction Internal carotid artery injury is a rare and severe intraoperative catastrophy. Endovascular treatment is the key to secure hemostasis. We aim to review our institutional results and learn from the experience.

Method We retrospectively reviewed all the patients undergoing neuro-endovascular intervention for the diagnosis of internal carotid artery injury during endoscopic transnasal transsphenoidal surgery between 2015 and 2019 in our institution.

Results We identified 4 patients with torrential intraoperative hemorrhage during endoscopic transnasal transphenoidal surgery requiring urgent catheter angiography. Three had diffuse subarachnoid hemorrhage and one had sole sellar hemorrhage. Diagnoses were pituitary marcoadenoma in 3 patients and mycosis in 1 patient. One aneurysm was embolized with coils and 2 patients were treated with main trunk occlusion together with the pseudoaneurysms. These 3 patients achieved favorable functional outcome upon discharge or after rehabilitation. One patient did not have angiographic cross-flow was treated with flow diverters. The patient remained dependent and succumbed one year later.

Conclusion In patients with torrential intraoperative hemorrhage during endoscopic transnasal transphenoidal surgery, endovascular treatment is frequently required and hemostasis could be secured.

Disclosures G. Wong: None.