Zachary M Kassir1, Paul A Gardner2, Eric W Wang3, Georgios A Zenonos2, Carl H Snyderman3. 1. School of Medicine, 12317University of Pittsburgh, Pittsburgh, Pennsylvania. 2. Department of Neurological Surgery, School of Medicine, 6614University of Pittsburgh, Pittsburgh, Pennsylvania. 3. Department of Otolaryngology, School of Medicine, 12317University of Pittsburgh, Pittsburgh, Pennsylvania.
Abstract
BACKGROUND: Injury to the internal carotid artery (ICA) is a potentially devastating complication of endoscopic endonasal surgery (EES) that as many as 20% of skull base surgeons will experience at least once during their careers. Managing these injuries is difficult given the small operative field and poor visibility created by high-flow hemorrhage, and, at present, there is no consensus regarding best practices. OBJECTIVE: This study seeks to consolidate the practices and opinions of experienced skull base surgeons from high-volume tertiary care centers into a single consensus statement regarding the best practices for managing ICA injuries during EES. METHODS: A panel of 23 skull base surgeons (15 neurosurgeons and 8 otolaryngologists) completed a 3-round Delphi survey that assessed experiences and opinions regarding various aspects of ICA injury management. Mean (SD) years since fellowship completion was 15.6 (8.1) and all but 3 surgeons had experienced an ICA injury at least once. RESULTS: The final consensus statement included 36 guidelines all of which were grouped under 1 of 4 categories: 11 statements concerned preoperative management and equipment for high-risk patients; 14 statements concerned hemorrhage control; 4 statements concerned definitive management; 7 statements concerned pharmacologic treatment, blood pressure, and neurophysiologic monitoring. CONCLUSIONS: There are numerous decisions that a surgeon must make when facing a carotid artery injury. In our estimation, many questions can be grouped under 1 of the 4 categories outlined in our consensus statement and can be addressed by these findings.
BACKGROUND: Injury to the internal carotid artery (ICA) is a potentially devastating complication of endoscopic endonasal surgery (EES) that as many as 20% of skull base surgeons will experience at least once during their careers. Managing these injuries is difficult given the small operative field and poor visibility created by high-flow hemorrhage, and, at present, there is no consensus regarding best practices. OBJECTIVE: This study seeks to consolidate the practices and opinions of experienced skull base surgeons from high-volume tertiary care centers into a single consensus statement regarding the best practices for managing ICA injuries during EES. METHODS: A panel of 23 skull base surgeons (15 neurosurgeons and 8 otolaryngologists) completed a 3-round Delphi survey that assessed experiences and opinions regarding various aspects of ICA injury management. Mean (SD) years since fellowship completion was 15.6 (8.1) and all but 3 surgeons had experienced an ICA injury at least once. RESULTS: The final consensus statement included 36 guidelines all of which were grouped under 1 of 4 categories: 11 statements concerned preoperative management and equipment for high-risk patients; 14 statements concerned hemorrhage control; 4 statements concerned definitive management; 7 statements concerned pharmacologic treatment, blood pressure, and neurophysiologic monitoring. CONCLUSIONS: There are numerous decisions that a surgeon must make when facing a carotid artery injury. In our estimation, many questions can be grouped under 1 of the 4 categories outlined in our consensus statement and can be addressed by these findings.
Authors: Dhiraj J Pangal; Guillaume Kugener; Yichao Zhu; Aditya Sinha; Vyom Unadkat; David J Cote; Ben Strickland; Martin Rutkowski; Andrew Hung; Animashree Anandkumar; X Y Han; Vardan Papyan; Bozena Wrobel; Gabriel Zada; Daniel A Donoho Journal: Sci Rep Date: 2022-05-17 Impact factor: 4.996