Safaee Michael, Young Jacob S, El-Sayed Ivan H, Theodosopoulos Philip V
Neurological Surgery, University of California, San Francisco, USA.
Otolaryngology Head and Neck Surgery, University of California, San Francisco, USA.
Cureus. 2019 Aug 30;11(8):e5537. doi: 10.7759/cureus.5537.
Arterial injuries are the most feared complication of endoscopic skull base surgery. During resection of the middle fossa component of a large ventral skull base chondrosarcoma, arterial bleeding was encountered near the right internal carotid artery (ICA). Durable hemostasis could not be achieved with packing and the patient was taken for an emergent angiogram that revealed a pseudoaneurysm of the proximal intradural ICA. Given the presence of good collateral flow through the anterior and posterior communicating arteries, the right ICA was sacrificed by coil embolization. The patient was taken back to the operating room for closure then transferred to the intensive care unit and maintained on vasopressors for five days to ensure adequate perfusion. The right ICA was coil embolized and the patient was taken back to the operating room for closure. The patient recovered without complication. Arterial injuries, although serious, are not always catastrophic. Critical steps are immediate recognition of bleeding, vascular imaging, and vessel sacrifice if necessary.
动脉损伤是内镜颅底手术最令人担忧的并发症。在切除大型腹侧颅底软骨肉瘤的中颅窝部分时，在右侧颈内动脉（ICA）附近遇到动脉出血。通过填塞无法实现持久止血，患者接受了急诊血管造影，结果显示近端硬脑膜内ICA存在假性动脉瘤。鉴于通过前交通动脉和后交通动脉存在良好的侧支血流，通过线圈栓塞牺牲了右侧ICA。患者被带回手术室进行缝合，然后转移到重症监护病房，并使用血管升压药维持五天以确保充足的灌注。右侧ICA进行了线圈栓塞，患者被带回手术室进行缝合。患者康复且无并发症。动脉损伤虽然严重，但并非总是灾难性的。关键步骤是立即识别出血、进行血管成像，并在必要时牺牲血管。
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