title: [Salvage management and subsequent treatment after internal carotid artery injury during transnasal endoscopic surgery].
abstract: OBJECTIVE
  To explore the cause, urgent management, further treatment, outcome and prevention of internal carotid artery (ICA) injury during transnasal endoscopic surgery.
  
  
  METHODS
  Five ICA injury happened during transnasal endoscopic surgery of sphenoidal sinus and (or) sellar region, involving 1 case of traumatic optic neuropathy, 1 case of sphenoidal cyst, 1 case of fungal sphenoid sinusitis, 1 case of sellar adenoid cystic carcinoma and 1 case of pituitary tumor. These five cases were from three different hospitals in 1990 - 2009, and the clinical data were collected and retrospectively reviewed.
  
  
  RESULTS
  Injury of ICA was related with improper anatomic localization and operative procedures. The locations of injury were in cavernous segment in 3 cases, lacerum segment in 1 case, and clinic segment in 1 case, respectively. The types of injury included 3 cases of bleeding of laceration, 1 case of carotid cavernous fistula and 1 case of pseudoaneurysm. Salvage sphenoid sinus packing with vaseline strip and subsequent intravascular stent graft implantation (2 cases) and endovascular embolization (2 cases) effectively controlled bleeding. Four cases were successfully treated without craniocerebral or ocular complications, only 1 case died of massive blood loss. Among 4 survival cases, 1 patient abandoned further therapy, the other 3 patients were cured of primary disease by reoperation or subsequent treatment.
  
  
  CONCLUSIONS
  Preoperatively, reading carefully the imaging data, intraoperatively, identifying anatomical positions accurately, performing proper operation, and stopping bleeding decidedly, postoperatively, seeking interdisciplinary cooperation to repair vascular damages, all these procedures can effectively reduce the surgical risk of ICA injury.
authors.affiliation: Otorhinolaryngology Hospital and Institute of the First Affiliated Hospital of SUN Yat-sen University, Guangzhou 510080, China.
authors.forename: Ke-jun
authors.initials: KJ
authors.lastname: Zuo
authors.forename: Rui
authors.initials: R
authors.lastname: Xu
authors.forename: Yin-yan
authors.initials: YY
authors.lastname: Lai
authors.forename: Zhan-quan
authors.initials: ZQ
authors.lastname: Yang
authors.forename: Qiu-hang
authors.initials: QH
authors.lastname: Zhang
authors.forename: Geng
authors.initials: G
authors.lastname: Xu
mesh_terms: D000293:Adolescent; D000368:Aged; D020212:Carotid Artery Injuries / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D002343:Carotid Artery, Internal; D004724:Endoscopy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000601:surgery*; D012189:Retrospective Studies