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.


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

Keywords: Complications; Endoscopic surgery; Hemorrhage; Internal carotid artery; Skull base.

Publication types

  • Review

MeSH terms

  • Carotid Artery Injuries / etiology*
  • Carotid Artery, Internal / diagnostic imaging
  • Checklist
  • Endoscopy / adverse effects*
  • Humans
  • Intraoperative Complications / prevention & control*
  • Neurosurgical Procedures / adverse effects*
  • Radiography
  • Risk Factors
  • Skull Base / surgery*