Intracranial Intradural Vascular Injury during Endoscopic Endonasal Transsphenoidal Surgery: A Case Report and Literature Review
| Autor: | Abdulrazag Ajlan, Yaser Babgi, Mohammed Babgi, Saad Alsaleh, Saleh S. Baeesa |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment lcsh:Surgery Case Report complication lcsh:RC346-429 Meningioma medicine.artery medicine Anterior cerebral artery intradural vascular injury lcsh:Neurology. Diseases of the nervous system Arterial injury Transsphenoidal surgery business.industry endoscopic endonasal approach lcsh:RD1-811 medicine.disease Surgery Anterior communicating artery Skull medicine.anatomical_structure endovascular Neurology (clinical) Internal carotid artery Complication business |
| Zdroj: | Journal of Neurological Surgery Reports, Vol 81, Iss 03, Pp e52-e58 (2020) Journal of Neurological Surgery Reports |
| ISSN: | 2193-6366 2193-6358 |
| DOI: | 10.1055/s-0040-1717056 |
| Popis: | Background Transsphenoidal surgery (TSS) is a procedure for sellar or midline masses in the skull base. Among the reported complications are iatrogenic vascular injuries; that are rare, yet they carry devastating outcomes, with an incidence of injury between 0.34 and 2.6%. The cavernous internal carotid artery is the most commonly injured. However, intradural arterial injuries are much less reported with challenging management. We report a rare incident of intradural arterial injury during TSS, and we compared our management to the summarized few cases reported in the literatureCase Report We report a 43-year-old female who had a recurrent planum sphenoidal meningioma. She underwent trans-nasal transsphenoidal endoscopic resection that was complicated with intraoperative bleeding due to an injury to the anterior communicating artery that was challenging to control, resulted in a bilateral loss of flow in A1 segments of anterior cerebral artery and required endovascular management. The patient had a good recovery postoperatively without the typical picture of ACA syndrome.Conclusion Intradural arterial injury is exceedingly rare in TSS, with no clear standard of care for the management. Collateral blood supply allows definitive management with minimal morbidity. Identifying the risk factors beforehand, as well as performing such cases in a well-resourced center, are crucial elements of safety. |
| Databáze: | OpenAIRE |
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