Management and outcome after internal carotid artery laceration during surgery of the paranasal sinuses

Abstract

Conclusions. The injury to the cavernous portion of the internal carotid artery (ICA) during endonasal sinus surgery is a potentially fatal complication, which can be prevented by systematic analysis of preoperative CT imaging in order to exclude vascular malformations. Immediate management is critical and requires interdisciplinary cooperation between the otolaryngologist and interventional neuroradiologist. Objective. The purpose of this article is to present two cases of injury to the cavernous portion of the ICA during routine endonasal sinus surgery for chronic sinusitis and to review the management and outcome of this vascular emergency. Patients and methods. A database of all patients surgically treated for chronic sinusitis between 1994 and 2004 was reviewed retrospectively. Additionally a review of the literature for all published case reports of ICA injury was performed. Results. We report two cases of ICA lacerations that occurred during routine endoscopic sinus surgery. Both patients were successfully treated by employing neuroradiological procedures including balloon and/or coil occlusion of various portions of the cavernous ICA. According to the literature the outcome depends on the presence or absence of vascular anomalies or aneurysm of the ICA with a very poor prognosis in cases of laceration of a pre-existing and unrecognized aneurysm.

Keywords:

• Bleeding
• neuroradiological treatment
• embolization
• endonasal surgery
• sphenoid sinus