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.

中文翻译：

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经蝶手术中的颈内动脉损伤：避免和修复的原则——临床研究


经蝶手术 (TSS) 最严重/可能致命的并发症之一是颈内动脉 (ICA) 损伤。在接受 TSS 的 6230 名患者中，8 名患者发生 ICA 损伤（0.12%）。分析了颈内动脉损伤的病因、可能的治疗方案和避免方法。 ICA损伤发生在两个不同的阶段：(1)暴露鞍底以及鞍和海绵窦上方的硬脑膜切口期间；(2)切除肿瘤的海绵窦延伸期间。血管造影侧支血液供应被分为良好、充足和不足，以帮助做出修复损伤的决策。损伤部位采用球囊ICA封堵2例，微弹簧圈2例，微弹簧圈加单筒颅外高流量旁路1例，支架移植1例，不干预2例。更好的术前准备、术中导航和超声多普勒描记可以降低 ICA 损伤的风险。应根据损伤部位和 ICA 的解剖特征来评估用于闭合缺损和恢复动脉血流的重建手术。