Prevention and Management of Bleeding During Endoscopic Approaches to Skull Base Pathologies

JHN Journal

Farrell, MD, Christopher J¹  Nyquist, MD, Gurston G.¹  Rosen, MD, Marc R.¹  Amenta, MD, Peter S²  Evans, MD, James J.¹  Mansouri, MD, Alireza³ 

[1] Thomas Jefferson UniversityThomas Jefferson UniversityThomas Jefferson University;Tulane University School of Medicine, New Orleans LATulane University School of Medicine, New Orleans LATulane University School of Medicine, New Orleans LA;University of TorontoUniversity of TorontoUniversity of Toronto

关键词: Prevention and Management of Bleeding During Endoscopic Approaches to Skull Base Pathologies;    Anatomy;    complications;    endoscopic;    management;   

DOI  :  

学科分类：农业科学（综合）

来源: Thomas Jefferson University * Department of Neurological Surgery

【 摘 要 】

The rate of serious permanent morbidity and mortality with endonasal approaches has declined secondary to increased knowledge of the pertinent anatomy, advanced neuroimaging and navigation techniques, better surgical instruments, and improved exposure and reconstruction strategies.1-3 Although rare, vascular injury remains a potentially serious complication. However, with limited systematically-collected and reported data, the exact incidence rate of vascular injuries is difficult to determine. In terms of arterial injuries, the incidence based on reported series likely ranges from 0.3%-9% (Table 1),4-11 with higher rates most commonly associated with chordomas and chondrosarcomas involving the clivus. Venous injury is comparatively less severe and easier to manage. As a result, there is a comparatively lower impetus to publish epidemiological data and management strategies for these injuries. The consequences of arterial injury include fatal hemorrhage, vessel occlusion or thromboembolism causing infarction, development of a pseudoaneurysm (PA), carotid-cavernous fistula (CCF), subarachnoid hemorrhage (SAH), and vasospasm.6,7,9 Surgical expertise and detailed knowledge of the neurovascular anatomy is critical to the avoidance and management of vascular injuries.Pages: 20-24

【 授权许可】

Unknown