Management of Major Vascular Injury During Endoscopic Endonasal Skull Base Surgery.
A major vascular injury is the most feared complication of endoscopic sinus and skull base surgery. Risk factors for vascular injury are discussed, and an algorithm for management of a major vascular injury is presented. A team of surgeons (otolaryngology and neurosurgery) is important for identification and control of a major vascular injury applying basic principles of vascular control. A variety of techniques can be used to control a major injury, including coagulation, a muscle patch, sacrifice of the artery, and angiographic stenting. Immediate and close angiographic follow-up is critical to prevent and manage subsequent complications of vascular injury.
Department of Neurological Surgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, PUH B-400, Pittsburgh, PA 15213, USA. Electronic address: gardpa@upmc.edu.
Paul A
PA
Gardner
Department of Neurological Surgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, PUH B-400, Pittsburgh, PA 15213, USA; Department of Otolaryngology, University of Pittsburgh School of Medicine, 200 Lothrop Street, EEI 500, Pittsburgh, PA 15213, USA.
Carl H
CH
Snyderman
Department of Neurological Surgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, PUH B-400, Pittsburgh, PA 15213, USA.
Juan C
JC
Fernandez-Miranda
Department of Neurological Surgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, PUH B-400, Pittsburgh, PA 15213, USA.
Brian T
BT
Jankowitz
D019468:Disease Management; D006488:Hemostasis, Surgical / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000601:surgery; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects* / Q000379:methods; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods; D019291:Skull Base / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods*; D057772:Vascular System Injuries / Q000209:etiology / Q000601:surgery
Endoscopic skull base surgery; Internal carotid artery; Pseudoaneurysm; Vascular injury