Iatrogenic carotid artery injury in neurosurgery

Abstract

Iatrogenic carotid artery injury (CAI) results from various neurosurgical procedures. A review of the literature was conducted to provide an update on the management of this potentially devastating complication. Iatrogenic CAIs are categorized according to each diagnostic or therapeutic procedure responsible for the injury, i.e., anterior cervical spine surgery, central venous catheterization, chemical substances, chiropractic manipulation, diagnostic cerebral angiography, middle-ear surgery, percutaneous procedures for trigeminal neuralgia, radiation therapy, skull-base surgery, tracheostomy, and transsphenoidal surgery. The incidence, mechanisms of injury, diagnostic imaging modalities, and reparative procedures are discussed for each procedure. Iatrogenic CAI may be more prevalent than had previously been thought, mostly because of a heightened awareness on the part of physicians and the earlier detection of asymptomatic patients owing to sophisticated and less-invasive imaging modalities. Prevention is the best treatment for every iatrogenic injury, and it is expected that further accumulation of experience with and knowledge of iatrogenic CAI will result in further reduction of this complication. Although some CAIs, such as radiation-induced carotid artery stenosis, may not be preventable, earlier intervention before the patient becomes symptomatic may favorably alter the prognosis. Following the rapid development of endovascular techniques in recent years, surgically inaccessible lesions can be treated in a more reliable and safe manner than before.

Anatomical Variations of the Common Carotid Artery Bifurcations in Relation to the Cervical Vertebrae in Ethiopia

“…The consequence of inadvertent carotid artery injury may be quite devastating, but its incidence can be reduced by understanding the mechanisms of injury, i.e., how and when it happens. Properly managing the complication can reduce a patient's mortality and morbidity [6].…”

Endoscopic direct vessel closure in carotid artery injury

“…1 There is no standard protocol for the management of CAI and at present nasal packing is the recommended form of management for this potentially catastrophic situation. [1][2][3] A number of packing materials have been described, including muslin gauze, fibrin glue, gel foam, and oxidized cellulose packing, as well as thrombin gelatin matrix. 1 However, packing has the potential for morbidity because "overpacking" may compromise blood flow and place important neurovascular structures at risk, resulting in poor perfusion and ischemia.…”

“…Nasal packing is therefore advocated over other management techniques. [1][2][3] "Overpacking" can, however, place important neurovascular structures at risk, so it is not without its own complications. 4 Attention has been turned more recently to alternatives in management.…”

Neuroendoscopic Transnasal Surgery for Skull Base Tumors: Basic Approaches, Avoidance of Pitfalls, and Recent Innovations

“…ICA injury during transsphenoidal surgery is reported to most frequently occur during dural incision of the sella floor. 1,4,9) The inner margin of the cavernous sinus and location of the ICA must be confirmed using the navigation system together with the micro-Doppler probe before dural incision. The clivus is observed just beneath the sella turcica and between the Neuroendoscopic Skull Base Surgery ICA eminences (Fig.…”