Emergency treatment and anesthesia management of internal carotid artery injury during neurosurgery: Four case reports
- PMID: 36186217
- PMCID: PMC9516918
- DOI: 10.12998/wjcc.v10.i27.9865
Emergency treatment and anesthesia management of internal carotid artery injury during neurosurgery: Four case reports
Abstract
Background: During skull base surgery, intraoperative internal carotid artery (ICA) injury is a catastrophic complication that can lead to fatal blood loss or secondary cerebral ischemia. Appropriate management of ICA injury plays a crucial role in the prognosis of patients. Neurosurgeons have reported multiple techniques and management strategies; however, the literature on managing this complication from the anesthesiologist's perspective is limited, especially in the aspect of circulation management and airway management when patients need transit for further endovascular treatment.
Case summary: We describe 4 cases of ICA injury during neurosurgery; there were 3 cases of pathologically proven pituitary adenoma and 1 case of cavernous sinus endothelial meningioma. After the onset of ICA injury, all four patients were immediately transferred for endovascular therapy under general anesthesia with vital signs monitored and mechanical ventilation. Three patients were transferred to the hybrid operating room, and one patient was transferred to the catheter operating room. Three patients underwent covered stent implantation, and one patient underwent embolization. All four patients experienced hypovolemic shock and received blood products infusion and vasoactive drugs to maintain stable circulation. After the neurosurgery, one patient was extubated and returned to the ward, and the other three were delayed tracheal extubation and returned to the intensive care unit. One patient died from serious neurological complications after 62 d in the hospital, but the other three showed good clinical outcomes.
Conclusion: ICA injury imposes a high risk of massive hemorrhage and subsequent infarction. Immediate treatment is critical and requires interdisciplinary collaboration among neurosurgeons, anesthesiologists, and interventional neuroradiologists. Effective hemostatic methods, stable hemodynamics sufficient to ensure perfusion of vital organs, airway safety during transit, rapid localization and implementation of appropriate measures to occlude the damaged vessel are strong guarantees of patient safety.
Keywords: Anesthesia Management; Case reports; Complication; Internal carotid artery injury; Literature review; Neurosurgery.
©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Conflict of interest statement
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Figures
![Figure 1](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/9516918/bin/WJCC-10-9865-g001.gif)
Similar articles
-
Development of a management protocol for internal carotid artery injury during endoscopic surgery: a modified Delphi method and single-center multidisciplinary working group.J Otolaryngol Head Neck Surg. 2022 Jul 28;51(1):30. doi: 10.1186/s40463-022-00582-w. J Otolaryngol Head Neck Surg. 2022. PMID: 35902904 Free PMC article.
-
Use of Adenosine to Facilitate Localization and Repair of Internal Carotid Artery Injury during Skull Base Surgery: A Case Report and Literature Review.Ann Otol Rhinol Laryngol. 2021 May;130(5):532-536. doi: 10.1177/0003489420956373. Epub 2020 Oct 8. Ann Otol Rhinol Laryngol. 2021. PMID: 33030046
-
A modified endovascular treatment protocol for iatrogenic internal carotid artery injuries following endoscopic endonasal surgery.J Neurosurg. 2019 Jan 25;132(2):343-350. doi: 10.3171/2018.8.JNS181048. J Neurosurg. 2019. PMID: 30684942
-
Endovascular management of internal carotid artery injuries secondary to endonasal surgery: case series and review of the literature.J Neurosurg. 2016 Nov;125(5):1256-1276. doi: 10.3171/2015.6.JNS142483. Epub 2016 Jan 15. J Neurosurg. 2016. PMID: 26771847 Review.
-
Internal carotid artery injury in endoscopic endonasal surgery: A systematic review.Laryngoscope. 2016 Mar;126(3):582-90. doi: 10.1002/lary.25748. Epub 2015 Nov 3. Laryngoscope. 2016. PMID: 26525334 Review.
References
-
- Van Der Veken J, Simons M, Mulcahy MJ, Wurster C, Harding M, Van Velthoven V. The surgical management of intraoperative intracranial internal carotid artery injury in open skull base surgery-a systematic review. Neurosurg Rev. 2022;45:1263–1273. - PubMed
-
- Inamasu J, Guiot BH. Iatrogenic carotid artery injury in neurosurgery. Neurosurg Rev. 2005;28:239–247; discussion 248. - PubMed
-
- AlQahtani A, London NR Jr, Castelnuovo P, Locatelli D, Stamm A, Cohen-Gadol AA, Elbosraty H, Casiano R, Morcos J, Pasquini E, Frank G, Mazzatenta D, Barkhoudarian G, Griffiths C, Kelly D, Georgalas C, Janakiram N, Nicolai P, Prevedello DM, Carrau RL. Assessment of Factors Associated With Internal Carotid Injury in Expanded Endoscopic Endonasal Skull Base Surgery. JAMA Otolaryngol Head Neck Surg. 2020;146:364–372. - PMC - PubMed
-
- Valentine R, Padhye V, Wormald PJ. Management of arterial injury during endoscopic sinus and skull base surgery. Curr Opin Otolaryngol Head Neck Surg. 2016;24:170–174. - PubMed
Publication types
LinkOut - more resources
Full Text Sources
Miscellaneous