Liu Ann, Rincon-Torroella Jordina, Bender Matthew T, McDougall Cameron G, Tufaro Anthony P, London Nyall R, Coon Alexander L, Reh Douglas D, Gallia Gary L
Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, United States.
Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, United States.
J Neurol Surg Rep. 2021 Dec 1;82(4):e43-e48. doi: 10.1055/s-0041-1735284. eCollection 2021 Oct.
The incidence of internal carotid artery (ICA) injury associated with endoscopic endonasal approaches to the pituitary is less than 1%. While parent vessel sacrifice has historically been the choice of treatment, vessel-preserving endovascular techniques have been reported. Although flow diversion offers endoluminal reconstruction, its major limitation is the delay in obtaining complete occlusion. We describe the use of a combined Pipeline embolization device (PED) with endoscopic endonasal repair using a fascia lata/muscle graft to treat an iatrogenic ICA pseudoaneurysm and report long-term radiographic follow-up. Further investigation into the utility of directed endoscopic endonasal repair of iatrogenic pseudoaneurysms initially treated with PED is necessary, especially given the need of post-PED anticoagulation and the rate of permanent neurological deficit after ICA sacrifice.
经鼻内镜垂体手术相关的颈内动脉（ICA）损伤发生率低于1%。虽然以往主要采用牺牲供血动脉的方法进行治疗，但也有报道采用保留血管的血管内技术。尽管血流导向装置可实现腔内重建，但其主要局限性在于完全闭塞的延迟。我们描述了使用Pipeline栓塞装置（PED）联合经鼻内镜筋膜 lata/肌肉移植修复治疗医源性ICA假性动脉瘤的方法，并报告了长期影像学随访结果。鉴于PED术后需要抗凝以及ICA牺牲后永久性神经功能缺损的发生率，有必要进一步研究对最初采用PED治疗的医源性假性动脉瘤进行定向经鼻内镜修复的实用性。
