Management of Major Vascular Injury During Endoscopic Endonasal Skull Base Surgery

Paul A Gardner; Carl H Snyderman; Juan C Fernandez-Miranda; Brian T Jankowitz

doi:10.1016/j.otc.2016.03.003

Management of Major Vascular Injury During Endoscopic Endonasal Skull Base Surgery

Otolaryngol Clin North Am. 2016 Jun;49(3):819-28. doi: 10.1016/j.otc.2016.03.003.

Authors

Paul A Gardner¹, Carl H Snyderman², Juan C Fernandez-Miranda³, Brian T Jankowitz³

Affiliations

¹ Department of Neurological Surgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, PUH B-400, Pittsburgh, PA 15213, USA. Electronic address: gardpa@upmc.edu.
² Department of Neurological Surgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, PUH B-400, Pittsburgh, PA 15213, USA; Department of Otolaryngology, University of Pittsburgh School of Medicine, 200 Lothrop Street, EEI 500, Pittsburgh, PA 15213, USA.
³ Department of Neurological Surgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, PUH B-400, Pittsburgh, PA 15213, USA.

PMID: 27267028
DOI: 10.1016/j.otc.2016.03.003

Abstract

A major vascular injury is the most feared complication of endoscopic sinus and skull base surgery. Risk factors for vascular injury are discussed, and an algorithm for management of a major vascular injury is presented. A team of surgeons (otolaryngology and neurosurgery) is important for identification and control of a major vascular injury applying basic principles of vascular control. A variety of techniques can be used to control a major injury, including coagulation, a muscle patch, sacrifice of the artery, and angiographic stenting. Immediate and close angiographic follow-up is critical to prevent and manage subsequent complications of vascular injury.

Keywords: Endoscopic skull base surgery; Internal carotid artery; Pseudoaneurysm; Vascular injury.

Publication types

Review

MeSH terms

Disease Management
Hemostasis, Surgical* / instrumentation
Hemostasis, Surgical* / methods
Humans
Intraoperative Complications* / etiology
Intraoperative Complications* / surgery
Natural Orifice Endoscopic Surgery / adverse effects*
Natural Orifice Endoscopic Surgery / methods
Neurosurgical Procedures / adverse effects*
Neurosurgical Procedures / methods
Skull Base / surgery*
Vascular Surgical Procedures / methods*
Vascular System Injuries* / etiology
Vascular System Injuries* / surgery