title: Internal carotid artery injury in endoscopic endonasal surgery: A systematic review.
abstract: OBJECTIVE
  Internal carotid artery (ICA) injury during endoscopic endonasal surgery (EES) is a known and feared complication of paranasal sinus and skull base procedures. These ICA injuries can result in stroke, cranial nerve palsies, and death. This review examines the setting of injury along with the treatment approaches, and patient outcomes.
  
  
  METHODS
  Systematic review using PubMed/MEDLINE and EMBASE.
  
  
  METHODS
  The databases were searched for articles reporting cases of ICA injury during EES. Variables analyzed included patient demographics, operative approach, preoperative diagnosis, setting of injury, repair method, imaging studies, patient outcomes, and follow-up.
  
  
  RESULTS
  Twenty-five articles with 50 cases were included in this review. The EES approach was used for skull base procedures in 34 cases and for inflammatory disease in 16 cases. The most commonly injured ICA segment was the cavernous (34 cases), followed by the ophthalmic (three cases). Injuries occurred more commonly on the left (1.3:1). Injury occurred in the setting of various steps during EES with instruments. Stereotactic image guidance was reported in two cases. Initial hemostasis was achieved with packing in 35 cases, endoscopic clip sacrifice in four cases, bipolar coagulation with the intent to seal defect in three cases, and bipolar coagulation with the intent to sacrifice the ICA in one case. Intraoperative or immediate postoperative angiography was reported in 27 cases.
  
  
  CONCLUSIONS
  The incidence of reported cases of ICA injury during EES remains low. Left-sided injuries to the cavernous segment of the ICA occurred more frequently than injuries on the right.
  
  
  METHODS
  NA Laryngoscope, 126:582-590, 2016.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.
authors.forename: Oliver Y
authors.initials: OY
authors.lastname: Chin
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.
authors.forename: Ritam
authors.initials: R
authors.lastname: Ghosh
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.
authors.forename: Christina H
authors.initials: CH
authors.lastname: Fang
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.|Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.
authors.forename: Soly
authors.initials: S
authors.lastname: Baredes
authors.affiliation: Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.|Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.
authors.forename: James K
authors.initials: JK
authors.lastname: Liu
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.|Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.|Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.|Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.
authors.forename: Jean Anderson
authors.initials: JA
authors.lastname: Eloy
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D020212:Carotid Artery Injuries / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D002343:Carotid Artery, Internal; D004724:Endoscopy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease; D015994:Incidence; D015601:Injury Severity Score; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000473:pathology / Q000601:surgery*; D011859:Radiography; D018570:Risk Assessment; D017678:Sex Distribution; D019291:Skull Base / Q000601:surgery*; D055815:Young Adult
keywords: Endoscopic sinus surgery; ICA injury; endoscopic endonasal approach; internal carotid artery injury; intraoperative complication; skull base surgery