Hemorrhagic direct traumatic carotid-cavernous fistula during endoscopic transsphenoidal surgery: intraoperative management and endovascular treatment
Giulia Cossu, MD,1 Tyler Atkins, MD,1 Steven D. Hajdu, MD,2 Francesco Puccinelli, MD,2
Roy T. Daniel, MD, MCh,1 and Mahmoud Messerer, MD, MSc1
Departments of 1Neurosurgery and 2Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
Include when citing: Published online April 1, 2020; DOI: [ Ссылка ]
Carotid-cavernous fistula (CCF) is a rare complication after transsphenoidal surgery with only 10 cases published (Ahuja et al., 1992; Cinar et al., 2013; Cossu et al., 2020; Dolenc et al., 1999; Kalia et al., 2009; Karaman et al., 2009; Kocer et al., 2002; Koitschev et al., 2006; Pigott et al., 1989; Takahashi et al., 1969). Intraoperative findings vary from unrecognized events to life-threatening hemorrhages.
We provide a description of the management of an acute CCF occurring during sphenoidotomy in a patient with pituitary apoplexy. Osteotomy performed in the rostrum resulted in a fracture, which extended toward the intracavernous carotid artery.
Bleeding was managed with mechanical compression. Endovascular treatment allowed closure of the fistula through transarterial coiling and glue. Arterial patency was preserved and the patient had no new neurological deficit.
Drilling should be considered over osteotomy for the anterior sphenoidotomy.
**Intro music: "Daybreak" by Graeme Rosner
