Department of Neurosurgery, Yangtze River Shipping General Hospital/Wuhan Brain Hospital, Wuhan, Hubei.
Department of Nursing, The Eighth Clinical Medical College, Guangzhou University of Traditional Chinese Medicine (Foshan Hospital of Traditional Chinese Medicine), Foshan, China.
J Craniofac Surg. 2024 Jun 1;35(4):1258-1260. doi: 10.1097/SCS.0000000000010174. Epub 2024 Apr 30.
Report on a case of pseudoaneurysm which was caused by injury of the internal carotid artery (ICA) during endoscopic endonasal surgery (EES), which was followed by rebleeding after treatment with a Willis covered stent.
A woman, aged 68, underwent EES for the treatment of a pituitary adenoma. During the surgery, the right ICA was injured, and successfully hemostasis by packed with cottonoid and gelatin sponge. Besides, cerebral angiography was performed in the interventional operating room for the purpose of discovering the formation of a pseudoaneurysm in the cavernous sinus segment of ICA, which was treated with a covered stent. After successfully placing the covered stent, the patient was promptly transferred to the general operating room for the removal of the cottonoid and to address the bleeding once again. The authors employ crushed muscles and cottonoid to locally compress and stop bleeding. Owing to concerns about the risk of rebleeding in the patient, after stent implantation, the patient did not utilize antiplatelet drugs. After the surgery, the patient developed occlusion of the right ICA and massive cerebral infarction in the right hemisphere. Dehydration, anti-infection, rehabilitation, hyperbaric oxygen, as well as related treatments, were given. The cottonoid was removed in EES 2 months postsurgery, and no instances of bleeding were observed. Six months after surgery, the patient had clear consciousness and hemiplegia in the left limb, with a Glasgow Outcome Scale score of 4.
The ICA was injured during EES, which resulted in the formation of a pseudoaneurysm, the Willis stent was adopted for treatment, and there was a risk of rebleeding after the nasal packing (cottonoid, crushed muscles) was removed immediately.
The ICA was injured during EES after bleeding was controlled by packing with cottonoid, crushed muscles, etc, subsequently, the patient was given intravascular treatment, it is advised to make thorough preparations and, after a suitable period, remove nasal packing in the hybrid operating room to address unexpected situations and unforeseen circumstances.
报告 1 例内镜经鼻蝶入路手术(EES)中损伤颈内动脉(ICA)导致假性动脉瘤,在使用 Willis 覆膜支架治疗后再次出血的病例。
1 例 68 岁女性患者,因垂体瘤行 EES 治疗。术中损伤右侧颈内动脉,用棉片和明胶海绵填塞成功止血。此外,在介入手术室行脑血管造影,发现颈内动脉海绵窦段假性动脉瘤形成,行覆膜支架治疗。覆膜支架成功放置后,患者立即转至普通手术室取出棉片再次止血。作者采用碎肌肉和棉片局部压迫止血。由于担心患者再出血的风险,支架植入后患者未使用抗血小板药物。术后患者出现右侧颈内动脉闭塞和右侧大脑半球大面积脑梗死。给予脱水、抗感染、康复、高压氧及相关治疗。术后 2 个月在 EES 取出棉片,未见出血。术后 6 个月,患者意识清楚,左侧肢体偏瘫,格拉斯哥预后评分 4 分。
EES 中 ICA 损伤,形成假性动脉瘤,采用 Willis 支架治疗,立即去除鼻腔填塞(棉片、碎肌肉)后有再出血风险。
EES 中 ICA 损伤,用棉片等填塞止血后,患者行血管内治疗,建议在杂交手术室做好充分准备,待合适时机在去除鼻腔填塞,以应对意外情况。