Simulating Internal Carotid Artery Injury during Transsphenoidal Transclival Endoscopic Surgery in a Perfused Cadaver Model
| Autor: | Tristan P.C. van Doormaal, Arvid Kropveld, Paul R.A.M. Depauw, Albert van der Zwan, Sander J.H. Diederen, Jan Willem Berkelbach |
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| Rok vydání: | 2017 |
| Předmět: |
Transsphenoidal surgery
medicine.medical_specialty Leak Endoscope business.industry medicine.medical_treatment Clipping (medicine) medicine.disease Surgery 03 medical and health sciences Stenosis 0302 clinical medicine medicine.artery Occlusion cardiovascular system medicine Neurology (clinical) Tamponade Internal carotid artery 030223 otorhinolaryngology business 030217 neurology & neurosurgery |
| Zdroj: | Journal of Neurological Surgery Part B: Skull Base. 79:161-166 |
| ISSN: | 2193-634X 2193-6331 |
| DOI: | 10.1055/s-0037-1605594 |
| Popis: | Introduction Managing internal carotid artery (ICA) injury during extended endoscopic transsphenoidal surgery is an extreme challenge. We aimed to find a possible surgical treatment strategy. Methods We operated seven fresh, perfused cadaver heads with a transsphenoidal endoscopic approach of the ICA using a three-dimensional-high definition (3D-HD) endoscope. We made a paraclival ICA leak, which we tried to manage with clips and microsutures. Results Accurate transsphenoidal clip application on the ICA was impossible with standard aneurysm clips and applier. It was only feasible with a 9 mm slightly bended clip that could be opened from the inside and be applied with a dedicated flexible thin applier. Transsphenoidal suturing of an ICA leak was impossible from the ipsilateral nostril or with standard microinstruments. Suturing was only feasible from the contralateral nostril using flexible microinstruments with a thin 90-mm shaft. This was technically very challenging and involved a steep learning curve. Conclusion Tamponade with muscle or fat and a quick transfer to the angiography suite for endovascular control remains the preferable option in case of an ICA leak during endoscopic transsphenoidal surgery. If tamponade gives insufficient initial control, ICA clipping could be possible with dedicated instruments, with risk of increasing the defect, stenosis, or occlusion of the vessel. Transsphenoidal ICA suturing remains extremely difficult, and laboratory practice seems essential. |
| Databáze: | OpenAIRE |
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