Management and outcome after internal carotid artery laceration during surgery of the paranasal sinuses

Abstract

We report two cases of ICA lacerations that occurred during routine endoscopic sinus surgery. Both patients were successfully treated by employing neuroradiological procedures including balloon and/or coil occlusion of various portions of the cavernous ICA. According to the literature the outcome depends on the presence or absence of vascular anomalies or aneurysm of the ICA with a very poor prognosis in cases of laceration of a pre-existing and unrecognized aneurysm.

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.…”

Verletzung der ACI bei Nasennebenhöhlenoperation und Management durch endovaskuläre Stentapplikation

“…Dabei bestand in 3 F ä llen eine bereits existierende vaskul ä re Malformation, die nicht erkannt wurde, in den beiden anderen F ä llen traten die Gef ä ß -l ä sionen bei Routineeingriff en auf. Nach diesen Daten betr ä gt die Ü berlebenswahrscheinlichkeit unter ausschlie ß licher Ber ü cksichtigung der F ä lle ohne pr ä existierender Gef ä ß malformationen 83 % (10 von 12) [4] . Betrachtet man die Behandlungsverfahren, so zeigt sich, dass seit 1989 in 11 von 16 F ä llen neben der Anlage einer Tamponade auch endovaskul ä re Therapiema ß -nahmen, wie Ballonokklusion und Embolisation, regelm ä ß ig durchgef ü hrt wurden.…”

“…Nach heutigen Erkenntnissen ist eine eff ektive und gezielte Versorgung nur durch neuroradiologische Ma ß nahmen sicher m ö glich. Dabei wird zun ä chst die genaue Blutungsquelle angiografi sch ermittelt und anschlie ß end mittels Ballon oder sogenannten Coils verschlossen [4] . Case report: We report on a twenty-fi ve-year-old female patient with acute exacerbated chronic polyposis nasi suff ering from an injury of the ICA during endonasal sinus surgery.…”

Complications of endoscopic sinus surgery: appropriate management of complications

“…In some patients this bone is dehiscent and the artery may get injured. In the presence of profuse bleeding, application of tight packing and compression of the common carotid artery in the neck is recommended, whereas immediate neurosurgical consultation is obtained to determine the need for endovascular treatment [23,24]. Postoperatively, computerized tomography imaging should be obtained while monitoring vitals signs for sudden changes that may indicate intracranial hemorrhage.…”