PDF(Pubmed)
Abstract：
BACKGROUND: During skull base surgery, intraoperative internal carotid artery (ICA) injury is a catastrophic complication that can lead to fatal blood loss or secondary cerebral ischemia. Appropriate management of ICA injury plays a crucial role in the prognosis of patients. Neurosurgeons have reported multiple techniques and management strategies; however, the literature on managing this complication from the anesthesiologist\'s perspective is limited, especially in the aspect of circulation management and airway management when patients need transit for further endovascular treatment.
METHODS: We describe 4 cases of ICA injury during neurosurgery; there were 3 cases of pathologically proven pituitary adenoma and 1 case of cavernous sinus endothelial meningioma. After the onset of ICA injury, all four patients were immediately transferred for endovascular therapy under general anesthesia with vital signs monitored and mechanical ventilation. Three patients were transferred to the hybrid operating room, and one patient was transferred to the catheter operating room. Three patients underwent covered stent implantation, and one patient underwent embolization. All four patients experienced hypovolemic shock and received blood products infusion and vasoactive drugs to maintain stable circulation. After the neurosurgery, one patient was extubated and returned to the ward, and the other three were delayed tracheal extubation and returned to the intensive care unit. One patient died from serious neurological complications after 62 d in the hospital, but the other three showed good clinical outcomes.
CONCLUSIONS: ICA injury imposes a high risk of massive hemorrhage and subsequent infarction. Immediate treatment is critical and requires interdisciplinary collaboration among neurosurgeons, anesthesiologists, and interventional neuroradiologists. Effective hemostatic methods, stable hemodynamics sufficient to ensure perfusion of vital organs, airway safety during transit, rapid localization and implementation of appropriate measures to occlude the damaged vessel are strong guarantees of patient safety.
METHODS: We describe 4 cases of ICA injury during neurosurgery; there were 3 cases of pathologically proven pituitary adenoma and 1 case of cavernous sinus endothelial meningioma. After the onset of ICA injury, all four patients were immediately transferred for endovascular therapy under general anesthesia with vital signs monitored and mechanical ventilation. Three patients were transferred to the hybrid operating room, and one patient was transferred to the catheter operating room. Three patients underwent covered stent implantation, and one patient underwent embolization. All four patients experienced hypovolemic shock and received blood products infusion and vasoactive drugs to maintain stable circulation. After the neurosurgery, one patient was extubated and returned to the ward, and the other three were delayed tracheal extubation and returned to the intensive care unit. One patient died from serious neurological complications after 62 d in the hospital, but the other three showed good clinical outcomes.
CONCLUSIONS: ICA injury imposes a high risk of massive hemorrhage and subsequent infarction. Immediate treatment is critical and requires interdisciplinary collaboration among neurosurgeons, anesthesiologists, and interventional neuroradiologists. Effective hemostatic methods, stable hemodynamics sufficient to ensure perfusion of vital organs, airway safety during transit, rapid localization and implementation of appropriate measures to occlude the damaged vessel are strong guarantees of patient safety.
摘要：
背景：在颅底手术期间，术中颈内动脉（ICA）损伤是一种灾难性的并发症，可导致致命的失血或继发性脑缺血。ICA损伤的适当处理对患者的预后起着至关重要的作用。神经外科医生报告了多种技术和管理策略；然而，从麻醉师的角度管理这种并发症的文献是有限的，特别是在循环管理和气道管理方面，当患者需要转运进行进一步的血管内治疗时。
方法：我们描述了神经外科手术中ICA损伤4例；经病理证实的垂体腺瘤3例，海绵窦内皮脑膜瘤1例。ICA受伤后,所有4例患者在全身麻醉下立即接受血管内治疗,监测生命体征并进行机械通气.三名患者被转移到混合手术室，一名患者被转移到导管手术室。三名患者接受了覆膜支架植入术，一名患者接受了栓塞治疗。所有四名患者都经历了低血容量性休克，并接受了血液制品输注和血管活性药物以维持稳定的循环。神经外科手术后,一名患者拔管并返回病房，另外3例延迟气管拔管并返回重症监护室。1例患者在医院62d后死于严重的神经系统并发症，但其他3例显示良好的临床结局.
结论：ICA损伤导致大出血和随后梗死的高风险。立即治疗至关重要，需要神经外科医生之间的跨学科合作，麻醉师,和介入神经放射科医生。有效的止血方法,稳定的血流动力学足以确保重要器官的灌注，运输过程中的气道安全，快速定位和实施适当的措施封堵受损血管是患者安全的有力保障。
方法：我们描述了神经外科手术中ICA损伤4例；经病理证实的垂体腺瘤3例，海绵窦内皮脑膜瘤1例。ICA受伤后,所有4例患者在全身麻醉下立即接受血管内治疗,监测生命体征并进行机械通气.三名患者被转移到混合手术室，一名患者被转移到导管手术室。三名患者接受了覆膜支架植入术，一名患者接受了栓塞治疗。所有四名患者都经历了低血容量性休克，并接受了血液制品输注和血管活性药物以维持稳定的循环。神经外科手术后,一名患者拔管并返回病房，另外3例延迟气管拔管并返回重症监护室。1例患者在医院62d后死于严重的神经系统并发症，但其他3例显示良好的临床结局.
结论：ICA损伤导致大出血和随后梗死的高风险。立即治疗至关重要，需要神经外科医生之间的跨学科合作，麻醉师,和介入神经放射科医生。有效的止血方法,稳定的血流动力学足以确保重要器官的灌注，运输过程中的气道安全，快速定位和实施适当的措施封堵受损血管是患者安全的有力保障。
