The Cavernous Segment of Internal Carotid Artery Injury in Endoscopic Transsphenoidal Surgery

Objectives: The internal carotid artery (ICA) injury is considered one of the most serious complications of transsphenoidal surgery.

Material and Methods: Five thousand tumors were operated by an endoscopic transsphenoidal approach at the N.N. Burdenko neurosurgery institute for the period from 2005 to November 2015. In 7 cases (0,14%) occurred the cavernous segment of ICA injury.

Results: All patients with the ICA injury underwent angiography which revealed false aneurysm formation in five cases (71.4%) and ICA occlusion in 1 case (14.3%). We put muscle plug in one case because of post-op angiogram in this case was normal.

A stent-graft was installed in 1 (14.3%) patient who later was discharged without any neurological symptoms. Balloon-occlusion for a false aneurysm was performed in 2 cases (28.6%): one patient died from ischemia and brain edema caused by collateral circulation insufficiency; the second patient was discharged without neurological complications. One patient (14.3%) developed an instant postoperative ICA occlusion died from ischemia and brain edema.

Conclusion: Damage to the ICA during transsphenoidal operations is a rare but potentially fatal complication. Thorough preoperative examinations (MRI and CT of the brain), use of different methods of intraoperative neuroimaging (navigation systems, intraoperative Dopplerography) will reduce the risk of this complication.