Abstract：
OBJECTIVE: Report on a case of pseudoaneurysm which was caused by injury of the internal carotid artery (ICA) during endoscopic endonasal surgery (EES), which was followed by rebleeding after treatment with a Willis covered stent.
METHODS: A woman, aged 68, underwent EES for the treatment of a pituitary adenoma. During the surgery, the right ICA was injured, and successfully hemostasis by packed with cottonoid and gelatin sponge. Besides, cerebral angiography was performed in the interventional operating room for the purpose of discovering the formation of a pseudoaneurysm in the cavernous sinus segment of ICA, which was treated with a covered stent. After successfully placing the covered stent, the patient was promptly transferred to the general operating room for the removal of the cottonoid and to address the bleeding once again. The authors employ crushed muscles and cottonoid to locally compress and stop bleeding. Owing to concerns about the risk of rebleeding in the patient, after stent implantation, the patient did not utilize antiplatelet drugs. After the surgery, the patient developed occlusion of the right ICA and massive cerebral infarction in the right hemisphere. Dehydration, anti-infection, rehabilitation, hyperbaric oxygen, as well as related treatments, were given. The cottonoid was removed in EES 2 months postsurgery, and no instances of bleeding were observed. Six months after surgery, the patient had clear consciousness and hemiplegia in the left limb, with a Glasgow Outcome Scale score of 4.
RESULTS: The ICA was injured during EES, which resulted in the formation of a pseudoaneurysm, the Willis stent was adopted for treatment, and there was a risk of rebleeding after the nasal packing (cottonoid, crushed muscles) was removed immediately.
CONCLUSIONS: The ICA was injured during EES after bleeding was controlled by packing with cottonoid, crushed muscles, etc, subsequently, the patient was given intravascular treatment, it is advised to make thorough preparations and, after a suitable period, remove nasal packing in the hybrid operating room to address unexpected situations and unforeseen circumstances.
METHODS: A woman, aged 68, underwent EES for the treatment of a pituitary adenoma. During the surgery, the right ICA was injured, and successfully hemostasis by packed with cottonoid and gelatin sponge. Besides, cerebral angiography was performed in the interventional operating room for the purpose of discovering the formation of a pseudoaneurysm in the cavernous sinus segment of ICA, which was treated with a covered stent. After successfully placing the covered stent, the patient was promptly transferred to the general operating room for the removal of the cottonoid and to address the bleeding once again. The authors employ crushed muscles and cottonoid to locally compress and stop bleeding. Owing to concerns about the risk of rebleeding in the patient, after stent implantation, the patient did not utilize antiplatelet drugs. After the surgery, the patient developed occlusion of the right ICA and massive cerebral infarction in the right hemisphere. Dehydration, anti-infection, rehabilitation, hyperbaric oxygen, as well as related treatments, were given. The cottonoid was removed in EES 2 months postsurgery, and no instances of bleeding were observed. Six months after surgery, the patient had clear consciousness and hemiplegia in the left limb, with a Glasgow Outcome Scale score of 4.
RESULTS: The ICA was injured during EES, which resulted in the formation of a pseudoaneurysm, the Willis stent was adopted for treatment, and there was a risk of rebleeding after the nasal packing (cottonoid, crushed muscles) was removed immediately.
CONCLUSIONS: The ICA was injured during EES after bleeding was controlled by packing with cottonoid, crushed muscles, etc, subsequently, the patient was given intravascular treatment, it is advised to make thorough preparations and, after a suitable period, remove nasal packing in the hybrid operating room to address unexpected situations and unforeseen circumstances.
摘要：
目的：报道一例鼻内镜手术（EES）中颈内动脉（ICA）损伤引起的假性动脉瘤，随后用Willis覆膜支架治疗后再出血。
方法：一个女人，68岁，接受了EES治疗垂体腺瘤。在手术过程中,正确的ICA受伤了，用棉质和明胶海绵包装成功止血。此外,在介入手术室进行脑血管造影，目的是发现ICA海绵窦段中假性动脉瘤的形成，用覆膜支架治疗。成功放置覆膜支架后，患者被迅速转移到普通手术室，以去除棉质并再次处理出血。作者使用压碎的肌肉和棉质来局部压缩和止血。由于担心患者的再出血风险，支架植入后，患者未使用抗血小板药物.手术后,患者出现右侧ICA闭塞和右半球大面积脑梗死。脱水,抗感染,康复,高压氧,以及相关的治疗方法，被给予了。在手术后2个月的EES中去除类棉，并且没有观察到出血的实例。手术后六个月,患者意识清晰，左肢偏瘫，格拉斯哥结果量表得分为4分。
结果：ICA在EES期间受伤，导致假性动脉瘤的形成，采用Willis支架治疗,鼻腔填塞后有再出血的风险(类棉，压碎的肌肉)立即移除。
结论：在EES期间，ICA受到损伤，出血是通过用棉花样包装来控制的，压碎的肌肉，etc,随后,患者接受血管内治疗,建议做好充分的准备，经过一段合适的时间，去除混合手术室的鼻塞，以解决意外情况和不可预见的情况。
方法：一个女人，68岁，接受了EES治疗垂体腺瘤。在手术过程中,正确的ICA受伤了，用棉质和明胶海绵包装成功止血。此外,在介入手术室进行脑血管造影，目的是发现ICA海绵窦段中假性动脉瘤的形成，用覆膜支架治疗。成功放置覆膜支架后，患者被迅速转移到普通手术室，以去除棉质并再次处理出血。作者使用压碎的肌肉和棉质来局部压缩和止血。由于担心患者的再出血风险，支架植入后，患者未使用抗血小板药物.手术后,患者出现右侧ICA闭塞和右半球大面积脑梗死。脱水,抗感染,康复,高压氧,以及相关的治疗方法，被给予了。在手术后2个月的EES中去除类棉，并且没有观察到出血的实例。手术后六个月,患者意识清晰，左肢偏瘫，格拉斯哥结果量表得分为4分。
结果：ICA在EES期间受伤，导致假性动脉瘤的形成，采用Willis支架治疗,鼻腔填塞后有再出血的风险(类棉，压碎的肌肉)立即移除。
结论：在EES期间，ICA受到损伤，出血是通过用棉花样包装来控制的，压碎的肌肉，etc,随后,患者接受血管内治疗,建议做好充分的准备，经过一段合适的时间，去除混合手术室的鼻塞，以解决意外情况和不可预见的情况。
