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Usachev D, Sharipov O, Abdali A, Yakovlev S, Lukshin V, Kutin M, Fomichev D, Dorokhov P, Bukharin E, Shkarubo A, Chernov I, Panteleyev A, Yağmurlu K, Chaurasia B, Kalinin P. Internal Carotid Artery Injury in Transsphenoidal Surgery: Tenets for Its Avoidance and Refit-A Clinical Study. Brain Sci 2021; 11:99. [PMID: 33451145 PMCID: PMC7828598 DOI: 10.3390/brainsci11010099] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/04/2021] [Accepted: 01/08/2021] [Indexed: 11/16/2022] Open
Abstract
One of the most serious/potentially fatal complications of transsphenoidal surgery (TSS) is internal carotid artery (ICA) injury. Of 6230 patients who underwent TSS, ICA injury occurred in 8 (0.12%). The etiology, possible treatment options, and avoidance of ICA injury were analyzed. ICA injury occurred at two different stages: (1) during the exposure of the sella floor and dural incision over the sella and cavernous sinus and (2) during the resection of the cavernous sinus extension of the tumor. The angiographic collateral blood supply was categorized as good, sufficient, and nonsufficient to help with the decision making for repairing the injury. ICA occlusion with a balloon was performed at the injury site in two cases, microcoils in two patients, microcoils plus a single barrel extra-intracranial high-flow bypass in one case, stent grafting in one case, and no intervention in two cases. The risk of ICA injury diminishes with better preoperative preparation, intraoperative navigation, and ultrasound dopplerography. Reconstructive surgery for closing the defect and restoring the blood flow to the artery should be assessed depending on the site of the injury and the anatomical features of the ICA.
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Affiliation(s)
- Dmitry Usachev
- N.N. Burdenko National Medical Research Center of Neurosurgery 4-ya Tverskaya-Yamskaya 16 st., 125047 Moscow, Russia; (D.U.); (O.S.); (S.Y.); (V.L.); (M.K.); (D.F.); (P.D.); (E.B.); (A.S.); (I.C.); (P.K.)
| | - Oleg Sharipov
- N.N. Burdenko National Medical Research Center of Neurosurgery 4-ya Tverskaya-Yamskaya 16 st., 125047 Moscow, Russia; (D.U.); (O.S.); (S.Y.); (V.L.); (M.K.); (D.F.); (P.D.); (E.B.); (A.S.); (I.C.); (P.K.)
| | - Ashraf Abdali
- N.N. Burdenko National Medical Research Center of Neurosurgery 4-ya Tverskaya-Yamskaya 16 st., 125047 Moscow, Russia; (D.U.); (O.S.); (S.Y.); (V.L.); (M.K.); (D.F.); (P.D.); (E.B.); (A.S.); (I.C.); (P.K.)
- Department of Neurological Diseases and Neurosurgery, Peoples’ Friendship University of Russia (RYDN University), Miklukho-Maklaya Street, 117198 Moscow, Russia
| | - Sergei Yakovlev
- N.N. Burdenko National Medical Research Center of Neurosurgery 4-ya Tverskaya-Yamskaya 16 st., 125047 Moscow, Russia; (D.U.); (O.S.); (S.Y.); (V.L.); (M.K.); (D.F.); (P.D.); (E.B.); (A.S.); (I.C.); (P.K.)
| | - Vasiliy Lukshin
- N.N. Burdenko National Medical Research Center of Neurosurgery 4-ya Tverskaya-Yamskaya 16 st., 125047 Moscow, Russia; (D.U.); (O.S.); (S.Y.); (V.L.); (M.K.); (D.F.); (P.D.); (E.B.); (A.S.); (I.C.); (P.K.)
| | - Maksim Kutin
- N.N. Burdenko National Medical Research Center of Neurosurgery 4-ya Tverskaya-Yamskaya 16 st., 125047 Moscow, Russia; (D.U.); (O.S.); (S.Y.); (V.L.); (M.K.); (D.F.); (P.D.); (E.B.); (A.S.); (I.C.); (P.K.)
| | - Dmitry Fomichev
- N.N. Burdenko National Medical Research Center of Neurosurgery 4-ya Tverskaya-Yamskaya 16 st., 125047 Moscow, Russia; (D.U.); (O.S.); (S.Y.); (V.L.); (M.K.); (D.F.); (P.D.); (E.B.); (A.S.); (I.C.); (P.K.)
| | - Pavel Dorokhov
- N.N. Burdenko National Medical Research Center of Neurosurgery 4-ya Tverskaya-Yamskaya 16 st., 125047 Moscow, Russia; (D.U.); (O.S.); (S.Y.); (V.L.); (M.K.); (D.F.); (P.D.); (E.B.); (A.S.); (I.C.); (P.K.)
| | - Evgeny Bukharin
- N.N. Burdenko National Medical Research Center of Neurosurgery 4-ya Tverskaya-Yamskaya 16 st., 125047 Moscow, Russia; (D.U.); (O.S.); (S.Y.); (V.L.); (M.K.); (D.F.); (P.D.); (E.B.); (A.S.); (I.C.); (P.K.)
| | - Alexey Shkarubo
- N.N. Burdenko National Medical Research Center of Neurosurgery 4-ya Tverskaya-Yamskaya 16 st., 125047 Moscow, Russia; (D.U.); (O.S.); (S.Y.); (V.L.); (M.K.); (D.F.); (P.D.); (E.B.); (A.S.); (I.C.); (P.K.)
| | - Ilya Chernov
- N.N. Burdenko National Medical Research Center of Neurosurgery 4-ya Tverskaya-Yamskaya 16 st., 125047 Moscow, Russia; (D.U.); (O.S.); (S.Y.); (V.L.); (M.K.); (D.F.); (P.D.); (E.B.); (A.S.); (I.C.); (P.K.)
| | - Andrey Panteleyev
- Department of Spine Pathology, N.N. Priorov Central Institute of Traumatology and Orthopedics, 125047 Moscow, Russia;
| | - Kaan Yağmurlu
- Departments of Neurosurgery and Neuroscience, University of Virginia, Charlottesville, VA 22903, USA;
| | - Bipin Chaurasia
- Department of Neurosurgery, Terai Hospital and Research Hospital, Birgunj 44400, Nepal;
| | - Pavel Kalinin
- N.N. Burdenko National Medical Research Center of Neurosurgery 4-ya Tverskaya-Yamskaya 16 st., 125047 Moscow, Russia; (D.U.); (O.S.); (S.Y.); (V.L.); (M.K.); (D.F.); (P.D.); (E.B.); (A.S.); (I.C.); (P.K.)
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