Extracranial-intracranial bypass using a cephalic vein graft for iatrogenic internal carotid artery injury during functional endoscopic sinus surgery: illustrative case.

Autor:	Wehbi N; University of Arizona College of Medicine-Phoenix, Phoenix, Arizona., Rahmani R; Departments of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona., Benet A; Departments of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona., Kim JE; Departments of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona., Scherschinski L; Departments of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona., Catapano JS; Departments of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona., Anthony AW; Departments of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona., Jadhav AP; Departments of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona., Ducruet AF; Departments of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona., Albuquerque FC; Departments of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona., Little AS; Departments of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona., Santarelli GD; Departments of Otolaryngology and Skull Base Surgery, Barrow Neurological Institute, Phoenix, Arizona., Stevens SM; Departments of Otolaryngology and Skull Base Surgery, Barrow Neurological Institute, Phoenix, Arizona., Jategaonkar AA; Departments of Otolaryngology and Skull Base Surgery, Barrow Neurological Institute, Phoenix, Arizona., Lawton MT; Departments of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery. Case lessons [J Neurosurg Case Lessons] 2024 Oct 14; Vol. 8 (16). Date of Electronic Publication: 2024 Oct 14 (Print Publication: 2024).
DOI:	10.3171/CASE24222
Abstrakt:	Background: Injury to the internal carotid artery (ICA) during functional endoscopic sinus surgery is a rare but potentially fatal complication. Although treatment algorithms have been developed, guidelines for effectively managing iatrogenic ICA injury have not been established. A case of ICA perforation during functional endoscopic sinus surgery treated with cerebral bypass utilizing a cephalic vein graft is presented. Observations: A woman in her late 50s presented with a left cavernous ICA injury that had occurred during endoscopic nasal polypectomy at an outside hospital. Hemostasis was achieved with intranasal Foley catheter placement. Left common carotid artery angiography revealed a high-flow carotid-cavernous fistula. Cerebral revascularization was chosen as the optimal procedure. The initial intent was to use a radial artery graft, but the radial artery was found to be occluded intraoperatively. Postoperatively, the patient experienced decreased vision and left eye movement but was otherwise neurologically intact. Postoperative angiography showed complete resolution of the fistula. Lessons: In cases involving ICA injury and carotid-cavernous fistula formation, microsurgical trapping with high-flow bypass is a favorable treatment option. The cephalic vein is a viable graft option when unexpected challenges arise with a radial artery graft. https://thejns.org/doi/10.3171/CASE24222.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu