背景:颈内动脉(ICA)损伤是鼻内镜手术(EES)的潜在破坏性并发症,多达20%的颅底外科医师在其职业生涯中至少会经历一次。由于高流量出血造成的手术视野小和能见度差,因此很难管理这些损伤。and,目前,关于最佳做法没有共识。
目的:本研究旨在将来自大批量三级护理中心的经验丰富的颅底外科医师的实践和意见整合为关于EES期间ICA损伤管理最佳实践的单一共识声明。
方法:由23名颅底外科医生(15名神经外科医生和8名耳鼻喉科医生)组成的小组完成了一项3轮Delphi调查,评估了关于ICA损伤处理各个方面的经验和意见。自完成研究金以来的平均(SD)年为15.6(8.1),除3名外科医生外,所有外科医生至少经历过一次ICA损伤。
结果:最终共识声明包括36条指南,所有指南分为4个类别中的1个:11条关于高危患者的术前管理和设备的声明;14条关于出血控制的声明;4条关于确定管理的声明;7条关于药物治疗的声明,血压,和神经生理监测。
结论:面对颈动脉损伤时,外科医生必须做出许多决定。据我们估计,许多问题可以归为我们共识声明中概述的4个类别中的1个,并可以通过这些发现来解决。
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.