Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

A Successful Control of the Intraoperative Bleeding from McConnell's Artery during Fully Endoscopic Resection of Planum Sphenoidale Meningioma Using Bone Chip and Bioglue : A Case Report

  • Received : 2024.07.26
  • Accepted : 2024.10.02
  • Published : 2025.03.01
Download PDF
⟨ Previous Next ⟩

Abstract

The endoscopic transsphenoidal approach is a common approach used in skull base neurosurgery to reach the sellar region. One of the intraoperative risks of this approach is intraoperative bleeding out of the carotid artery. Gentle drilling can prevent carotid artery injury. However, injury to smaller branches, such as the McConnell's capsular artery, which is located within the surgical corridor, is more difficult to prevent. If such an injury is within the junction to the main trunk of the carotid artery, there will be a small circular defect in this area. This can result in massive blood loss and should be closed surgically immediately. We describe a clinical case of intraoperative bleeding from the McConnell's artery originating from the carotid arterial segment (C4) in a 78-year-old female patient operated on for planum sphenoidale meningioma via endoscopic transsphenoidal approach, as well as provide a technical note on a possible technique for bleeding control in such cases. Pinpoint carotid bleeding as a result of intraoperative injury can be stopped by wedging a bone fragment in the carotid canal and fixing it in that position with histoacryl glue at the defect site.

Keywords

References

  1. Cavallo LM, Briganti F, Cappabianca P, Maiuri F, Valente V, Tortora F, et al. : Hemorrhagic vascular complications of endoscopic transsphenoidal surgery. Minim Invasive Neurosurg 47 : 145-150, 2004 https://doi.org/10.1055/s-2004-818489
  2. Charalampaki P, Ayyad A, Kockro RA, Perneczky A : Surgical complications after endoscopic transsphenoidal pituitary surgery. J Clin Neurosci 16 : 786-789, 2009 https://doi.org/10.1016/j.jocn.2008.09.002
  3. Ciric I, Ragin A, Baumgartner C, Pierce D : Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurgery 40 : 225-236; discussion 236-237, 1997 https://doi.org/10.1097/00006123-199702000-00001
  4. Debus ES, Grundmann RT : Acute carotid part 3: artery injury. Gefasschirurgie 25 : 356-363, 2020 https://doi.org/10.1007/s00772-020-00635-2
  5. Ferrareze Nunes C, Beer-Furlan A, Doglietto F, Carrau RL, Prevedello DM : The McConnell's capsular arteries and their relevance in endoscopic endonasal approach to the sellar region. Oper Neurosurg (Hagerstown) 14 : 171-177, 2018 https://doi.org/10.1093/ons/opx107
  6. Gardner PA, Snyderman CH, Fernandez-Miranda JC, Jankowitz BT : Management of major vascular injury during endoscopic endonasal skull base surgery. Otolaryngol Clin North Am 49 : 819-828, 2016 https://doi.org/10.1016/j.otc.2016.03.003
  7. Gardner PA, Tormenti MJ, Pant H, Fernandez-Miranda JC, Snyderman CH, Horowitz MB : Carotid artery injury during endoscopic endonasal skull base surgery: incidence and outcomes. Neurosurgery 73(2 Suppl Operative) : ons261-ons269; discussion ons269-ons270, 2013 https://doi.org/10.1227/01.neu.0000430821.71267.f2
  8. Kalinin PL, Sharipov OI, Shkarubo AN, Fomichev DV, Kutin MA, Alekseev SN, et al. : Damage to the cavernous segment of internal carotid artery in transsphenoidal endoscopic removal of pituitary adenomas (report of 4 cases). Zh Vopr Neirokhir Im N N Burdenko 77 : 28-37, 2013
  9. Li C, Zhu H, Zong X, Wang X, Gui S, Zhao P, et al. : Experience of trans-nasal endoscopic surgery for pituitary tumors in a single center in China : surgical results in a cohort of 2032 patients, operated between 2006 and 2018. Clin Neurol Neurosurg 197 : 106176, 2020
  10. Oskouian RJ, Kelly DF, Laws ERJ Jr : Vascular injury and transsphenoidal surgery. Front Horm Res 34 : 256-278, 2006 https://doi.org/10.1159/000091586
  11. Padhye V, Valentine R, Wormald PJ : Management of carotid artery injury in endonasal surgery. Int Arch Otorhinolaryngol 18(Suppl 2) : S173-S178, 2014 https://doi.org/10.1055/s-0034-1395266
  12. Raymond J, Hardy J, Czepko R, Roy D : Arterial injuries in transsphenoidal surgery for pituitary adenoma; the role of angiography and endovascular treatment. AJNR Am J Neuroradiol 18 : 655-665, 1997
  13. Rhoton AL Jr : Cranial Anatomy and Surgical Approach. Philadelphia : Lippincott Williams & Wilkins, 2003
  14. Romero ADCB, Lal Gangadharan J, Bander ED, Gobin YP, Anand VK, Schwartz TH : Managing arterial injury in endoscopic skull base surgery: case series and review of the literature. Oper Neurosurg (Hagerstown) 13 : 138-149, 2017 https://doi.org/10.1227/NEU.0000000000001180
  15. Rowan NR, Turner MT, Valappil B, Fernandez-Miranda JC, Wang EW, Gardner PA, et al. : Injury of the carotid artery during endoscopic endonasal surgery: surveys of skull base surgeons. J Neurol Surg B Skull Base 79 : 302-308, 2018 https://doi.org/10.1055/s-0037-1607314
  16. Sharma RK, Irace AL, Overdevest JB, Gudis DA : Carotid artery injury in endoscopic endonasal surgery: risk factors, prevention, and management. World J Otorhinolaryngol Head Neck Surg 8 : 54-60, 2022 https://doi.org/10.1002/wjo2.7
  17. Valentine R, Padhye V, Wormald PJ : Management of arterial injury during endoscopic sinus and skull base surgery. Curr Opin Otolaryngol Head Neck Surg 24 : 170-174, 2016 https://doi.org/10.1097/MOO.0000000000000239
  18. Wang WH, Lieber S, Lan MY, Wang EW, Fernandez-Miranda JC, Snyderman CH, et al. : Nasopharyngeal muscle patch for the management of internal carotid artery injury in endoscopic endonasal surgery. J Neurosurg 133 : 1382-1387, 2020 https://doi.org/10.3171/2019.7.JNS191370
  19. Zhang Y, Tian Z, Li C, Liu J, Zhang Y, Yang X, et al. : A modified endovascular treatment protocol for iatrogenic internal carotid artery injuries following endoscopic endonasal surgery. J Neurosurg 132 : 343-350, 2020 https://doi.org/10.3171/2018.8.JNS181048