Internal carotid artery injury during functional endoscopic sinus surgery and its management

Abstract

Rupture of the internal carotid artery (ICA) during functional endoscopic sinus surgery (FESS) is a rare complication, which can potentially result in death. Only a few cases have been reported in the literature thus far. We present four cases with an ICA bleeding during sphenoidotomy. The treatment is discussed and an emergency plan to manage the heavy arterial bleeding is presented.

Surgical measurement to sphenoid sinus for the Chinese in Asia based on CT using sagittal reconstruction images

“…Sphenoid sinus wall is thin and vulnerable; blindly scraping or tearing sphenoid sinus mucosa can easily damage the wall of sphenoid sinus and the optic nerve or carotid artery, as well as the anterior cranial fossa [4] and the pituitary gland, thus resulting in serious complications for the suVerers. Kaori et al [5][6][7] previously put the emphasis on the optic nerve and carotid artery in the study; however, there has been no detailed investigative report concerning the spatial distance from the sphenoid ostium to the skull base and sella. The present results indicate that the distance from the sphenoid ostium to the anterior skull base and sella will be of great importance to us to avoid such injuries.…”

Pitfalls in Sinus Surgery

“…6). [31][32][33] ICA dehiscence can be a normal anatomic variant (see Fig. 6A) or may be secondary to destruction or deossification from disease processes (see Fig.…”

Posttreatment Imaging of the Paranasal Sinuses Following Endoscopic Sinus Surgery

“…34,35 Injury to some of these vessels may be predisposed by preexisting dehiscences in the skull base and not only by iatrogenic defects, hence the importance of preoperative sinus CT evaluation and/or intraoperative imaging guidance. Patients with postoperative epistaxis may warrant angiography in order to identify the source of hemorrhage, which can manifest as pseudoaneurysm.…”