Carotid Artery Injury During Skull Base Surgery

Internal carotid artery injury is a challenging complication in endoscopic sinus and skull base surgery. When this complication occurs in endoscopic skull base surgery, it is best managed with an experienced skull base team. Knowledge of the vascular anatomy, assessment of the tumor involvement and intraoperative planning is critical for the successful management of this complication. Establishing intraoperative hemostasis while maintaining visualization is the first goal. After this is achieved, vessel management with bipolar cauterization, aneurysm clip application and/or muscle patching with focal packing can be considered. In larger injuries, carotid sacrifice may be indicated. Immediate postoperative angiogram is imperative in the management of this injury for diagnosis and potential treatment.