School of Medicine, 12317University of Pittsburgh, Pittsburgh, Pennsylvania.
Department of Neurological Surgery, School of Medicine, 6614University of Pittsburgh, Pittsburgh, Pennsylvania.
Am J Rhinol Allergy. 2021 Nov;35(6):885-894. doi: 10.1177/19458924211024864. Epub 2021 Jul 8.
Injury to the internal carotid artery (ICA) is a potentially devastating complication of endoscopic endonasal surgery (EES) that as many as 20% of skull base surgeons will experience at least once during their careers. Managing these injuries is difficult given the small operative field and poor visibility created by high-flow hemorrhage, and, at present, there is no consensus regarding best practices.
This study seeks to consolidate the practices and opinions of experienced skull base surgeons from high-volume tertiary care centers into a single consensus statement regarding the best practices for managing ICA injuries during EES.
A panel of 23 skull base surgeons (15 neurosurgeons and 8 otolaryngologists) completed a 3-round Delphi survey that assessed experiences and opinions regarding various aspects of ICA injury management. Mean (SD) years since fellowship completion was 15.6 (8.1) and all but 3 surgeons had experienced an ICA injury at least once.
The final consensus statement included 36 guidelines all of which were grouped under 1 of 4 categories: 11 statements concerned preoperative management and equipment for high-risk patients; 14 statements concerned hemorrhage control; 4 statements concerned definitive management; 7 statements concerned pharmacologic treatment, blood pressure, and neurophysiologic monitoring.
There are numerous decisions that a surgeon must make when facing a carotid artery injury. In our estimation, many questions can be grouped under 1 of the 4 categories outlined in our consensus statement and can be addressed by these findings.
内镜经鼻颅底手术（EES）中损伤颈内动脉（ICA）是一种潜在的毁灭性并发症，多达 20%的颅底外科医生在其职业生涯中至少会遇到一次。由于手术视野小，且高流量出血导致可视性差，处理这些损伤具有挑战性，目前，关于最佳实践方法还没有共识。
本研究旨在将高容量三级护理中心经验丰富的颅底外科医生的实践和意见整合到一个关于 EES 期间处理 ICA 损伤的最佳实践的共识声明中。
一个由 23 名颅底外科医生（15 名神经外科医生和 8 名耳鼻喉科医生）组成的小组完成了 3 轮 Delphi 调查，该调查评估了他们在处理 ICA 损伤的各个方面的经验和意见。完成住院医师培训后的平均（SD）年限为 15.6（8.1）年，除了 3 名外科医生外，其余所有人都至少经历过一次 ICA 损伤。
最终的共识声明包括 36 条指南，这些指南全部被分为以下 4 类之一：11 条与高危患者的术前管理和设备有关；14 条与控制出血有关；4 条与确定性管理有关；7 条与药物治疗、血压和神经生理监测有关。
当面对颈动脉损伤时，外科医生必须做出许多决定。我们估计，许多问题可以归为我们共识声明中列出的 4 类中的一类，并且可以通过这些发现来解决。
