PDF(Pubmed)
Abstract：
Objectives Iatrogenic injury to the internal carotid artery (ICA) is one of the most catastrophic complications of endoscopic sinus and skull base surgery. Previous research has shown that packing with a crushed muscle graft at the injury site can be an effective management technique to control bleeding and prevent the need for ICA sacrifice. Here, we describe a novel and readily available repair donor site-an autologous lateral tongue muscle patch. Design Three representative cases of a successful repair of ICA injuries using a lateral tongue muscle patch are included in this study. The graft measured approximately 2 × 3 cm and was taken from the lateral intrinsic tongue musculature. We describe the harvest of the graft, its advantages, and the details of operative repair. Results The lateral tongue provides a large and readily accessible source of muscle within the surgical field that can be quickly harvested during an endoscopic procedure. For the first case, an expanding parasellar ICA pseudoaneurysm was managed with a tongue muscle patch and nasal packing. In the second case, a cavernous ICA injury was sustained during craniopharyngioma resection. Case three involved an ICA injury during endonasal debridement of invasive fungal rhinosinusitis. None of the patients required embolization or neurovascular stenting. Postoperative angiograms and serial computed tomography angiograms showed complete resolution of the pseudoaneurysm, and the patients continued to do well at least 1 year after repair. Conclusion Lateral tongue muscle graft is an effective and efficient method to manage ICA injuries during endoscopic endonasal surgery. Advantages include the speed of harvest, donor site being readily accessible in the surgical field, and low donor site morbidity. It should be added to the repertoire of possible donor sites for addressing catastrophic sinonasal bleeding.
摘要：
目的颈内动脉（ICA）的医源性损伤是内窥镜鼻窦和颅底手术最严重的并发症之一。先前的研究表明，在损伤部位用压碎的肌肉移植物包装可以是控制出血和防止ICA牺牲的有效管理技术。这里,我们描述了一种新颖且易于获得的修复供体部位-自体舌侧肌补片。设计本研究包括使用舌侧肌补片成功修复ICA损伤的三个代表性案例。移植物的尺寸约为2×3cm，取自外侧固有的舌头肌肉组织。我们描述了嫁接的收获，其优势,和手术修理的细节。结果外侧舌在手术区域内提供了大的且容易接近的肌肉来源,其可以在内窥镜手术期间快速收获。对于第一种情况，通过舌肌补片和鼻腔填塞治疗不断扩大的鞍旁ICA假性动脉瘤。在第二种情况下，颅咽管瘤切除术期间出现海绵状ICA损伤.病例3涉及侵袭性真菌性鼻窦炎鼻内清创期间的ICA损伤。没有患者需要栓塞或神经血管支架置入术。术后血管造影和连续计算机断层扫描血管造影显示假性动脉瘤完全消退，修复后至少1年，患者仍保持良好状态。结论舌侧肌移植是治疗鼻内镜手术中ICA损伤的有效方法。优势包括收获的速度，供体部位在手术领域很容易接近，和低供体部位发病率。应将其添加到可能的供体部位库中，以解决灾难性的鼻窦出血。
