Otolaryngology Department, Queen Elizabeth Hospital, Birmingham, UK.
Neurosurgery Department, Queen Elizabeth Hospital, Birmingham, UK.
Br J Neurosurg. 2024 Aug;38(4):934-938. doi: 10.1080/02688697.2021.2011138. Epub 2022 May 13.
Although rare, injury to the internal carotid artery (ICA) during pituitary surgery may result in serious morbidity such as stroke or death. This case series explores a single centre's incidence and outcomes of ICA injury during endoscopic transsphenoidal pituitary surgery, discusses the current management options, and introduces the 'muscle wonton' (morcellised muscle wrapped in a single sheet of Surgicel) as being a viable repair option.
All patients undergoing pituitary operations from January 2010 to December 2019 at the Queen Elizabeth Hospital, Birmingham, UK were included. Primary outcome was number of internal carotid artery injuries during pituitary surgery. Secondary outcome measures included pre-operative (demographic, risk factors such as previous radiotherapy, number of previous operations, imaging available), operative (intra-operative image guidance, intra-operative doppler ultrasound, which side ICA was damaged, repair technique) and post-operative result (death, cranial nerve VI palsy, or stroke).
7 out of 893 patients (0.8%) were identified as having an ICA injury. Four of the injuries were left sided. Average age was 54 years old, five were male. In four of the ICA injuries intra-operative navigation imaging was used, and a further two concurrently used ultrasound doppler. Three of the seven cases resulted in permanent morbidity (stroke). There were no other consistent demographic, pre-operative, operative, or post-operative similarities. The two patients with muscle wonton repair suffered no permanent serious complication of ICA injury (i.e. death, abducens nerve palsy, stroke).
Our findings resemble the current literature, with left sided ICA injury being more common. Different methods for repairing ICA injury exist, however morcellised muscle patches have shown significant promise in animal models, and the perforated Surgicel helps create an easy delivery method. The muscle wonton is a viable surgical option for repairing ICA injuries during pituitary surgery.
尽管罕见，但在经蝶窦垂体手术中损伤颈内动脉（ICA）可能导致严重的发病率，如中风或死亡。本病例系列探讨了单一中心内镜经蝶窦垂体手术中 ICA 损伤的发生率和结果，讨论了当前的管理选择，并介绍了“肌肉馄饨”（包裹在 Surgicel 单层中的切碎肌肉）作为一种可行的修复选择。
纳入 2010 年 1 月至 2019 年 12 月期间在英国伯明翰伊丽莎白女王医院接受垂体手术的所有患者。主要结果是垂体手术中 ICA 损伤的数量。次要结果指标包括术前（人口统计学，危险因素，如既往放疗，手术次数，影像学资料）、术中（术中图像引导，术中多普勒超声，ICA 损伤的哪一侧，修复技术）和术后结果（死亡，第六颅神经麻痹或中风）。
在 893 例患者中发现 7 例（0.8%）有 ICA 损伤。其中 4 例为左侧损伤。平均年龄为 54 岁，男性 5 例。在 4 例 ICA 损伤中使用了术中导航成像，另外 2 例同时使用了超声多普勒。7 例中的 3 例导致永久性发病率（中风）。没有其他一致的人口统计学、术前、术中或术后相似性。接受肌肉馄饨修复的 2 例患者没有发生永久性严重的 ICA 损伤并发症（即死亡、外展神经麻痹、中风）。
我们的发现与当前文献相似，左侧 ICA 损伤更为常见。修复 ICA 损伤的方法不同，但切碎肌肉补丁在动物模型中显示出了显著的前景，而穿孔的 Surgicel 有助于创造一种简单的输送方法。肌肉馄饨是修复垂体手术中 ICA 损伤的一种可行的手术选择。
