Injury of the Internal Carotid Artery During Endoscopic Skull Base Surgery: Prevention and Management Protocol

AbdulAziz AlQahtani; Paolo Castelnuovo; Piero Nicolai; Daniel M Prevedello; Davide Locatelli; Ricardo L Carrau

doi:10.1016/j.otc.2015.09.009

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.

Authors

AbdulAziz AlQahtani¹, Paolo Castelnuovo², Piero Nicolai³, Daniel M Prevedello⁴, Davide Locatelli⁵, Ricardo L Carrau⁶

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
² Department of Otorhinolaryngology, University of Insubria, Varese, Italy.
³ Department of Otorhinolaryngology, University of Brescia, Brescia, Italy.
⁴ Department of Neurosurgery, Wexner Medical Center at the Ohio State University, Columbus, OH, USA; Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at the Ohio State University, Columbus, OH, USA.
⁵ Department of Neurosurgery, University of Insubria, Varese, Italy.
⁶ Department of Neurosurgery, Wexner Medical Center at the Ohio State University, Columbus, OH, USA; Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at the Ohio State University, Columbus, OH, USA. Electronic address: carraurl@gmail.com.

PMID: 26614841
DOI: 10.1016/j.otc.2015.09.009

Abstract

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*