Rupture of intracranial aneurysm resulting in subarachnoid hemorrhage is well known to carry significant risk of poor outcome. Intra-operative rupture of an unknown intracranial aneurysm during a neurosurgical procedu...Rupture of intracranial aneurysm resulting in subarachnoid hemorrhage is well known to carry significant risk of poor outcome. Intra-operative rupture of an unknown intracranial aneurysm during a neurosurgical procedure is a rare occurrence that can lead to devastating consequences if not recognized and managed appropriately. Here we describe to our knowledge, the first reported case of previously unknown, remote from the surgical site, intra-operative posterior cerebral artery aneurysm rupture during transnasal endoscopic transphenoidal resection of a pituitary macroadenoma, review relevant literature, and discuss strategies to reduce surgical risk and improve patient outcomes.展开更多
Objective:Endoscopic approaches for sinus and skull base surgery are increasing in popularity.The objective of this narrative review is to characterize risk factors for internal carotid artery injury in endoscopic end...Objective:Endoscopic approaches for sinus and skull base surgery are increasing in popularity.The objective of this narrative review is to characterize risk factors for internal carotid artery injury in endoscopic endonasal surgery(EES),highlight preventative measures,and illustrate key management principles.Data Sources:Comprehensive literature review.Methods:Relevant literature was reviewed using PubMed/MEDLINE.Results:Carotid artery injury in EES is rare,with most studies reporting an incidence below 0.1%.Anatomic aberrancies,wide dissection margins,as well as specific provider and hospital factors,may increase the risk of injury.Multidisciplinary teams,comprehensive preoperative imaging,patient risk assessment,and formal training in vascular emergencies may reduce the risk.Management protocols should emphasize proper visualization of the injury site,fluid replacement,rapid packing,angiography,and endovascular techniques to achieve hemostasis.Conclusions:While EES is a relatively safe procedure,carotid artery injury is a devastating complication that warrants full consideration in surgical planning.Important preventative measures include identifying patients with notable risk factors and obtaining preoperative imaging.Multidisciplinary teams and management protocols are ultimately necessary to reduce morbidity and mortality.展开更多
文摘Rupture of intracranial aneurysm resulting in subarachnoid hemorrhage is well known to carry significant risk of poor outcome. Intra-operative rupture of an unknown intracranial aneurysm during a neurosurgical procedure is a rare occurrence that can lead to devastating consequences if not recognized and managed appropriately. Here we describe to our knowledge, the first reported case of previously unknown, remote from the surgical site, intra-operative posterior cerebral artery aneurysm rupture during transnasal endoscopic transphenoidal resection of a pituitary macroadenoma, review relevant literature, and discuss strategies to reduce surgical risk and improve patient outcomes.
文摘Objective:Endoscopic approaches for sinus and skull base surgery are increasing in popularity.The objective of this narrative review is to characterize risk factors for internal carotid artery injury in endoscopic endonasal surgery(EES),highlight preventative measures,and illustrate key management principles.Data Sources:Comprehensive literature review.Methods:Relevant literature was reviewed using PubMed/MEDLINE.Results:Carotid artery injury in EES is rare,with most studies reporting an incidence below 0.1%.Anatomic aberrancies,wide dissection margins,as well as specific provider and hospital factors,may increase the risk of injury.Multidisciplinary teams,comprehensive preoperative imaging,patient risk assessment,and formal training in vascular emergencies may reduce the risk.Management protocols should emphasize proper visualization of the injury site,fluid replacement,rapid packing,angiography,and endovascular techniques to achieve hemostasis.Conclusions:While EES is a relatively safe procedure,carotid artery injury is a devastating complication that warrants full consideration in surgical planning.Important preventative measures include identifying patients with notable risk factors and obtaining preoperative imaging.Multidisciplinary teams and management protocols are ultimately necessary to reduce morbidity and mortality.
