Endovascular Management of Vascular Injury during Transsphenoidal Surgery

Abstract

<jats:p> Vascular injury is an unusual and serious complication of transsphenoidal surgery. We aimed to define the role of angiography and endovascular treatment in patients with vascular injuries occurring during transsphenoidal surgery. </jats:p><jats:p> During the last ten-year period, we retrospectively evaluated nine patients with vascular injury after transsphenoidal surgery. Eight patients were symptomatic due to vascular injury, while one had only suspicion of vascular injury during surgery. Four patients presented with epistaxis, two with subarachnoid hemorrhage, one with exophthalmos, and one with hemiparesia. Emergency angiography revealed a pseudoaneurysm in four patients, contrast extravasation in two, vessel dissection in one, vessel wall irregularity in one, and arteriovenous fistula in one. All patients but one were treated successfully with parent artery occlusion, with one covered stent implantation, one stent-assisted coiling method, while one patient was managed conservatively. One patient died due to complications related to the primary insult without rebleeding. </jats:p><jats:p> Vascular injuries suspected intra or postoperatively must be investigated rapidly after transsphenoidal surgery. Endovascular treatment with parent artery occlusion is feasible with acceptable morbidity and mortality rates in the treatment of vascular injuries occurring in transsphenoidal surgery. </jats:p>

Sphenopalatine arteriovenous fistula complicating transsphenoidal pituitary surgery: A rare cause of delayed epistaxis treatable by endovascular embolization

“…The most commonly reported vascular injuries are those concerning the internal carotid artery (reported to occur in 1.1% of all transsphenoidal operations), and include laceration, perforation, avulsion of dural branches, thrombosis, and other forms of injury that can cause massive hemorrhage, stroke, or lead to the formation of pseudoaneurysms and carotid-cavernous fistulas. [134] Risk factors for iatrogenic internal carotid artery injury include large invasive adenomas, previous transsphenoidal surgery, previous radiation therapy, medical therapy (prolonged dopamine agonist treatment), and aggressive surgery of lesions invading the cavernous sinus. [4]…”

Cervical–petrous internal carotid artery pseudoaneurysm presenting with otorrhagia treated with endovascular techniques

“…Surgical excision of a cervical ICA aneurysm with end to end anastomosis has also been performed 5. Endovascular techniques have included balloon embolization,3 6 coil embolization,7 8 20 stand-alone stenting (typically with a covered stent),8–11 14 21 23 stent-assisted coiling,26 and flow diversion 27–29. The bleeding27 and thromboembolic complication29 rate may be higher with flow diversion.…”

Traumatic Pseudoaneurysm in Maxillary Sinus Presenting Intractable Epistaxis: A Case Report of Transarterial Embolization

“…Some internal carotid artery aneurysms are associated with iatrogenic factors, such as transsphenoidal surgery and irradiation. 1,2) Pseudoaneurysms of the external carotid artery system frequently cause intermittent massive epistaxis as the initial symptom. 3,4) As responsible blood vessels, branches at the maxillary artery region, such as the sphenopalatine, infraorbital, and alveolar arteries, have been reported.…”