Zuo Ke-jun, Xu Rui, Lai Yin-yan, Yang Zhan-quan, Zhang Qiu-hang, Xu Geng
Otorhinolaryngology Hospital and Institute of the First Affiliated Hospital of SUN Yat-sen University, Guangzhou 510080, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2012 Jul;47(7):554-8.
To explore the cause, urgent management, further treatment, outcome and prevention of internal carotid artery (ICA) injury during transnasal endoscopic surgery.
Five ICA injury happened during transnasal endoscopic surgery of sphenoidal sinus and (or) sellar region, involving 1 case of traumatic optic neuropathy, 1 case of sphenoidal cyst, 1 case of fungal sphenoid sinusitis, 1 case of sellar adenoid cystic carcinoma and 1 case of pituitary tumor. These five cases were from three different hospitals in 1990 - 2009, and the clinical data were collected and retrospectively reviewed.
Injury of ICA was related with improper anatomic localization and operative procedures. The locations of injury were in cavernous segment in 3 cases, lacerum segment in 1 case, and clinic segment in 1 case, respectively. The types of injury included 3 cases of bleeding of laceration, 1 case of carotid cavernous fistula and 1 case of pseudoaneurysm. Salvage sphenoid sinus packing with vaseline strip and subsequent intravascular stent graft implantation (2 cases) and endovascular embolization (2 cases) effectively controlled bleeding. Four cases were successfully treated without craniocerebral or ocular complications, only 1 case died of massive blood loss. Among 4 survival cases, 1 patient abandoned further therapy, the other 3 patients were cured of primary disease by reoperation or subsequent treatment.
Preoperatively, reading carefully the imaging data, intraoperatively, identifying anatomical positions accurately, performing proper operation, and stopping bleeding decidedly, postoperatively, seeking interdisciplinary cooperation to repair vascular damages, all these procedures can effectively reduce the surgical risk of ICA injury.
探讨经鼻内镜手术中颈内动脉（ICA）损伤的原因、紧急处理、进一步治疗、结局及预防措施。
5例颈内动脉损伤发生在经鼻内镜蝶窦和（或）鞍区手术中，涉及创伤性视神经病变1例、蝶窦囊肿1例、真菌性蝶窦炎1例、鞍区腺样囊性癌1例和垂体瘤1例。这5例来自1990年至2009年的3家不同医院，收集临床资料并进行回顾性分析。
颈内动脉损伤与解剖定位不当及手术操作有关。损伤部位分别为海绵窦段3例、破裂段1例、临床段1例。损伤类型包括撕裂伤出血3例、颈内动脉海绵窦瘘1例、假性动脉瘤1例。采用凡士林条填塞蝶窦并随后植入血管内支架移植物（2例）和血管内栓塞（2例）有效控制了出血。4例成功治疗，无颅脑或眼部并发症，仅1例死于大出血。在4例存活病例中，1例患者放弃进一步治疗，其他3例患者通过再次手术或后续治疗治愈了原发疾病。
术前仔细阅读影像学资料，术中准确识别解剖位置，进行恰当操作并果断止血，术后寻求多学科合作修复血管损伤，这些措施均可有效降低颈内动脉损伤的手术风险。
