Management of an Internal Carotid Artery Injury During Open Skull Base Surgery With a Crushed Muscle Patch – Technical Note and Lessons Learned

Veken, Jorn Van Der; Mascarenhas, Annika; Chryssidis, Steve; Poonoose, Santosh Isaac

doi:10.1093/ons/opab267

Cited by 3 publications

(4 citation statements)

References 25 publications

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“…Recent studies have shown placing a crushed muscle patch over the injury site could result in complete haemostasis and good results. Crushing the muscle releases thrombotic agents and induces pathways resulting in haemostasis 14–16 …”

Section: Discussionmentioning

confidence: 99%

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Internal carotid artery injury during endoscopic endonasal surgery for skull base pathologies: an institutional incidence, management, and outcome

Iranmehr

Sarpoolaki

Sadrehosseini

et al. 2023

ANZ Journal of Surgery

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Background: Endoscopic endonasal surgery (EES) has become a popular approach to deal with skull base pathologies. The most catastrophic intra-operative complication of EES is internal carotid artery (ICA) injury. We aim to discuss and introduce our institutional experience with ICA injury during EES. Methods: A retrospective review of patients who underwent EES from 2013 to 2022 was performed to determine the incidence and outcomes of intraoperative ICA injuries. Results: There were six patients (0.56%) with intraoperative ICA injury in our institution during the last 10 years. Fortunately, there was no morbidity or mortality in our patients with intraoperative ICA injuries. The sites of injury were equally in paraclival, cavernous sinus, and preclinoidal segments of ICA. Conclusion: Primary prevention is the best solution for this condition. Regarding our institutional experience, the best option for primary management just after an injury is packing the surgical site. In cases where packing is not enough for temporary control of bleeding, common carotid artery occlusion should be considered. We have presented our experience and reviewed previous studies regarding different treatments and suggested our intra and post-operative management algorithm.

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Section: Discussionmentioning

confidence: 99%

“…Crushing the muscle releases thrombotic agents and induces pathways resulting in haemostasis. [14][15][16] The first DSA is usually done just after surgery and the second during 5-7 days after the incident. Arterial wall injuries can be dynamic and further follow-up in these patients is critical.…”

Section: Discussionmentioning

confidence: 99%

Internal carotid artery injury during endoscopic endonasal surgery for skull base pathologies: an institutional incidence, management, and outcome

Iranmehr

Sarpoolaki

Sadrehosseini

et al. 2023

ANZ Journal of Surgery

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“…Muscle grafts prove to be one of the most effective methods of controlling hemorrhage in ICA injuries [7][8][9] . Several different donor sites for crushed muscle grafts have been described, including the sternocleidomastoid (SCM), nasopharynx, and tensor fascia lata.…”

Section: Introductionmentioning

confidence: 99%

“…Muscle grafts prove to be one of the most effective methods of controlling hemorrhage in ICA injuries. [7][8][9] Several different donor sites for crushed muscle grafts have been described, including the sternocleidomastoid (SCM), nasopharynx, and tensor fascia lata. 4,10,11 Several emergency protocols and management strategies involving muscle or fascia grafts for immediate control of ICA hemorrhage have been published since 2005.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Repair of Internal Carotid Artery Injury with a Lateral Tongue Muscle Patch Graft: Novel Technique and Literature Review

Chapurin

Sharma

Stevens

et al. 2023

J Neurol Surg B Skull Base

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Objectives: Iatrogenic injury to the internal carotid artery (ICA) is one of the most catastrophic complications of endoscopic sinus and skull base surgery. Previous research has shown that packing with a crushed muscle graft at the injury site can be an effective management technique to control bleeding and prevent the need for ICA sacrifice. Here we describe a novel and readily available repair donor site – an autologous lateral tongue muscle patch. Design: Three representative cases of a successful repair of ICA injuries using a lateral tongue muscle patch. The graft measured approximately 2 x 3 cm and was taken from the lateral intrinsic tongue musculature. We describe the harvest of the graft, its advantages, and the details of operative repair. Results: For the first case, an expanding parasellar ICA pseudoaneurysm was managed with a tongue muscle patch and nasal packing. In the second case, a cavernous ICA injury was sustained during craniopharyngioma resection. Case three involved an ICA injury during endonasal debridement of invasive fungal rhinosinusitis (IFS). Postoperative angiograms and serial CTAs showed complete resolution of the pseudoaneurysm, and the patients continue to do well 1 year after repair. Conclusions: Lateral tongue muscle graft is an effective and efficient method to manage ICA injuries during endoscopic endonasal surgery. Advantages include the speed of harvest, donor site being readily accessible in the surgical field, and low donor site morbidity. It should be added to the repertoire of possible donor sites for addressing catastrophic sinonasal bleeding.

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The surgical management of intraoperative intracranial internal carotid artery injury in open skull base surgery—a systematic review

et al. 2021

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Intraoperative internal carotid artery (ICA) injury during open skull base surgery is a catastrophic complication. Multiple techniques and management strategies have been reported for endoscopic skull base surgery; however, the literature on managing this complication in open skull base surgery is limited. To perform a systematic review and give an overview of the different techniques described to manage this complication intraoperatively, a systematic review was conducted in PubMed, Ovid Medline, Ovid Embase and Scopus for literature published until July 2021. Titles and abstracts were screened. Studies meeting prespecified inclusion criteria were reviewed in full. PRISMA guidelines were strictly adhered to. Out of 4492 articles, only 12 articles could be included, reflecting an underreporting of open skull base ICA injuries. Multiple techniques can be used depending on the location and size of the injury as well as the surgeon's experience. Described techniques include the following: a primary repair via a micro-suture or nonpenetrating clips; wrapping or plugging; coating; occlusion of the parent artery with or without a bypass; packing with further endovascular management. A treatment algorithm is proposed.

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Management of an Internal Carotid Artery Injury During Open Skull Base Surgery With a Crushed Muscle Patch – Technical Note and Lessons Learned

Cited by 3 publications

References 25 publications

Internal carotid artery injury during endoscopic endonasal surgery for skull base pathologies: an institutional incidence, management, and outcome

Internal carotid artery injury during endoscopic endonasal surgery for skull base pathologies: an institutional incidence, management, and outcome

Endoscopic Repair of Internal Carotid Artery Injury with a Lateral Tongue Muscle Patch Graft: Novel Technique and Literature Review

The surgical management of intraoperative intracranial internal carotid artery injury in open skull base surgery—a systematic review

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