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internal_carotid_artery_injury

Internal carotid artery injury

Injury of the internal carotid artery during endoscopic endonasal skull base surgery is a feared and perilous scenario.

The intercarotid distance (ICD) is thus a major parameter, determining the width of the surgical corridor in TSS. The purpose of the study is to investigate changes in ICD at different levels of the ICA during and after TSS using high definition intraoperative MRI (3T-iMRI).

Pre-, intra- and 3 months postoperative MRI images of 85 TSS patients were reviewed. ICD was measured at the horizontal (ICDC4h) and vertical (ICDC4v) intracavernous C4 segment as well as at the C6 segment (ICDC6). Association between ICD change at different levels and time points were compared and potential factors predicting ICD reduction were analyzed.

ICD decreased intraoperatively at all three segments of ICA by -3% (median decreases: ICDC4h: -0.5 mm, ICDC4v: -0.7 mm ICDC6: -0.4 mm). At 3 months postoperative MRI, ICD reduced by a further -4%, -2% and -4% respectively (median decreases ICDC4h: -0.7, ICDC4v: -0.4 mm, ICDC6: -0.5 mm). Postoperative narrowing in ICD occurred independent of further resection after 3T-iMRI. ICD change correlated between different levels of the ICA indicating a uniform shift perioperatively. Preoperative ICD was significantly associated with the intraoperative reduction in ICDC4v and ICDC6.

Serra et al. have demonstrated a uniform narrowing in ICD at different levels of the ICA during and after TSS adenoma resection. Surgeons should be aware of this change since it determines the width of the surgical corridor and can thus influence the ease of surgery 1).


The article of AlQahtani et al. discusses perioperative strategies to prevent or manage an internal carotid artery injury to optimize outcomes. Meticulous preoperative planning is crucial in preventing its occurrence and minimizing its consequences. An effective plan of action relies on a well-prepared protocol, availability of proper instruments and devices, and an experienced multidisciplinary team. Intraoperative control of hemorrhage and stabilization of the patient's cardiovascular status is followed by an angiography and endovascular treatment whenever possible. Close clinical and radiologic monitoring of the patient prevents early and late complications 2).


Endovascular Extraction of a Needle from the Internal Carotid Artery: A Novel Approach to a Controversial Dental Misadventure 3).

1)
Serra C, Maldaner N, Muscas G, Staartjes V, Pangalu A, Holzmann D, Soyka M, Schmid C, Regli L. The changing sella: internal carotid artery shift during transsphenoidal pituitary surgery. Pituitary. 2017 Aug 21. doi: 10.1007/s11102-017-0830-x. [Epub ahead of print] PubMed PMID: 28828722.
2)
AlQahtani A, Castelnuovo P, Nicolai P, Prevedello DM, Locatelli D, Carrau RL. Injury of the Internal Carotid Artery During Endoscopic Skull Base Surgery: Prevention and Management Protocol. Otolaryngol Clin North Am. 2016 Feb;49(1):237-52. doi: 10.1016/j.otc.2015.09.009. Review. PubMed PMID: 26614841.
3)
Giurintano JP, Somerville J, Sebelik M, Hoit D, Michael LM 3rd, Shires CB. Endovascular Extraction of a Needle from the Internal Carotid Artery: A Novel Approach to a Controversial Dental Misadventure. J Neurol Surg Rep. 2017 Jul;78(3):e106-e108. doi: 10.1055/s-0037-1604282. Epub 2017 Aug 23. PubMed PMID: 28845380; PubMed Central PMCID: PMC5568860.
internal_carotid_artery_injury.txt · Last modified: 2017/08/29 17:35 by administrador