Treatment of Ruptured ICA during Transsphenoidal Surgery

Ghatge, S.; Modi, Dhaval B

doi:10.1177/159101991001600104

Cited by 15 publications

(3 citation statements)

References 15 publications

(14 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Two intervention strategies have been reported including the occlusion of the ICA, which needs adequate cross-flow, or the implant of a stent graft to cover the ICA's pathologic segment. 5 8 9 10 In this report the patient had limited endovascular options because collateral blood flow was thought to be insufficient and the cavernous segment of the ICA was ectatic, preventing the implant of a stent. In this rare condition, surgical treatment with an extracranial-intracranial bypass (EC-IC bypass) and ICA trapping can be considered.…”

Section: Discussionmentioning

confidence: 92%

Surgical Treatment of Inadvertent Internal Carotid Artery Lesion by Extraintracranial High-flow Bypass. A Case Report and Review of the Literature

et al. 2015

View full text Add to dashboard Cite

Internal carotid artery (ICA) injury following transsphenoidal surgery is a rare but potentially fatal complication. Usually, endovascular occlusion of the ICA or stent graft placement is the treatment of these vascular complications described in literature. We present a case of ICA perforation during transsphenoidal surgery in a patient with limited collateral cerebral blood flow and with ectasia of the ICA that rule out an endovascular treatment. We report the surgical revascularization via high-flow extra-intracranial radial artery bypass and consicutive artery ligation.

show abstract

Section: Discussionmentioning

confidence: 92%

Surgical Treatment of Inadvertent Internal Carotid Artery Lesion by Extraintracranial High-flow Bypass. A Case Report and Review of the Literature

et al. 2015

View full text Add to dashboard Cite

show abstract

“… 11 15 17 Similar to most ICA injury cases during TSS, that was ultimately managed with endovascular parent artery occlusion. 17 22 In one case reported by Romero et al, multiple trials to preserve the ACA had failed and the patient ultimately required occlusion of the parent artery. Furthermore, the patient experienced multiple dissecting aneurysms in the ICA.…”

Section: Discussionmentioning

confidence: 99%

Intracranial Intradural Vascular Injury during Endoscopic Endonasal Transsphenoidal Surgery: A Case Report and Literature Review

et al. 2020

View full text Add to dashboard Cite

Background Transsphenoidal surgery (TSS) is a procedure for sellar or midline masses in the skull base. Among the reported complications are iatrogenic vascular injuries; that are rare, yet they carry devastating outcomes, with an incidence of injury between 0.34 and 2.6%. The cavernous internal carotid artery is the most commonly injured. However, intradural arterial injuries are much less reported with challenging management. We report a rare incident of intradural arterial injury during TSS, and we compared our management to the summarized few cases reported in the literature Case Report We report a 43-year-old female who had a recurrent planum sphenoidal meningioma. She underwent trans-nasal transsphenoidal endoscopic resection that was complicated with intraoperative bleeding due to an injury to the anterior communicating artery that was challenging to control, resulted in a bilateral loss of flow in A1 segments of anterior cerebral artery and required endovascular management. The patient had a good recovery postoperatively without the typical picture of ACA syndrome. Conclusion Intradural arterial injury is exceedingly rare in TSS, with no clear standard of care for the management. Collateral blood supply allows definitive management with minimal morbidity. Identifying the risk factors beforehand, as well as performing such cases in a well-resourced center, are crucial elements of safety.

show abstract

“…[ 31 ] Thus, the exact cause of this peculiar peak in incidence remains unclear; however, it certainly raises concerns about the potential coexistence of an ICA aneurysm in the setting of an adenoma which may lead to hemorrhagic complications such as subarachnoid hemorrhage, carotid cavernous fistula, pituitary apoplexy, and intraoperative massive bleeding. [ 3 7 10 12 15 16 30 39 ] Therefore, a detailed assessment and review of the cerebral vasculature on presurgical MRI scans is required.…”

Section: Discussionmentioning

confidence: 99%

Enlargement of an incidental internal carotid artery aneurysm embedded in pituitary adenoma associated with medical shrinkage of the tumor: Case report

Khachatryan¹,

Khachatryan²,

Fanarjyan³

et al. 2018

Surg Neurol Int

View full text Add to dashboard Cite

Background:Currently, transsphenoidal surgery (TSS) is the preferred method for surgical treatment of intrasellar pituitary adenomas. However, it carries some risk of intraoperative arterial injuries, which is mainly attributed to direct iatrogenic rupture of the internal carotid artery (ICA). There is anecdotal evidence suggesting that intracranial aneurysms are coincidentally found significantly more frequently in the setting of pituitary adenomas than when the incidence is compared to other intracranial neoplasms. The exact cause of this discrepancy remains unclear, but it certainly raises concerns about the potential existence of an ICA aneurysm, which might be encountered during TSS and in some cases may cause hemorrhagic complications.Case Description:We present a case of a patient who was found to have a growth hormone (GH)-secreting pituitary adenoma and a coexisting cavernous ICA aneurysm which was embedded within the tumor. The patient underwent medical treatment of the adenoma. However, shrinkage of the tumor was associated with enlargement of the observed aneurysm, warranting endovascular intervention.Conclusions:This case report is an illustration for physicians to be conscientious about the potential danger posed by the coexistence of an intratumoral aneurysm in the setting of a pituitary adenoma. Special attention should be given to recognition of an intrinsic flow void signal on the presurgical imaging of the tumor, and if observed, magnetic resonance angiography (MRA) should be performed for preoperative planning. If MRA is not performed routinely, detailed review of high-resolution magnetic resonance imaging is recommended to detect any flow artifacts suggestive of an aneurysm.

show abstract

Treatment of Ruptured ICA during Transsphenoidal Surgery

Cited by 15 publications

References 15 publications

Surgical Treatment of Inadvertent Internal Carotid Artery Lesion by Extraintracranial High-flow Bypass. A Case Report and Review of the Literature

Surgical Treatment of Inadvertent Internal Carotid Artery Lesion by Extraintracranial High-flow Bypass. A Case Report and Review of the Literature

Intracranial Intradural Vascular Injury during Endoscopic Endonasal Transsphenoidal Surgery: A Case Report and Literature Review

Enlargement of an incidental internal carotid artery aneurysm embedded in pituitary adenoma associated with medical shrinkage of the tumor: Case report

Contact Info

Product

Resources

About