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  • Urgent Cerebral Revascularization Bypass Surgery for Iatrogenic Skull Base ICA Injury

    Final Number:

    Leonardo Rangel-Castilla MD; Cameron G. McDougall MD; Elad I. Levy MD, FACS, FAHA, FAANS; Robert F. Spetzler MD; Peter Nakaji MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: When feasible, the management of iatrogenic internal carotid artery (ICA) injury during skull base surgery is mainly endovascular. We propose a cerebral revascularization procedure as a rescue option when endovascular treatment is not feasible.

    Methods: We retrospectively reviewed all extracranial-intracranial (EC-IC) bypass procedures performed between 6/2007 and 1/2014.

    Results: From 235 procedures, we identified 8 consecutive patients with iatrogenic ICA injury managed with an EC-IC bypass. Injury to the ICA occurred during an endoscopic transphenoidal surgery (n=3), endoscopic transfacial-transmaxilar surgery (n=1), myringotomy (n=1), cavernos sinus meningioma resection (n=1), posterior communicating artery aneurysm clipping (n=1), and cavernous ICA aneurysm coiling (n=1). Endovascular management was considered as first line treatment but was not successful. All cases received a high-flow EC-IC bypass. At a mean clinical/radiographic follow-up of 19 months (range, 3-36), all patients had a modified Rankin scale score of 0 or 1. All bypasses remained patent.

    Conclusions: Iatrogenic injury of the skull base ICA is uncommon but can lead to lethal consequences. Many injuries can be treated with endovascular techniques. However, certain cases may still require a cerebral revascularization procedure.

    Patient Care: Prevent catastrophic consecuences secondary to traumatic skull base internal carotid artery injury when endosvascular techniques are not feasible

    Learning Objectives: To assess the limitation of endovascular techniques in the mangement of traumatic internal carotid artery injury. To understand the importance of cerebral revascularization procedures in urgent internal carotid injury


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