Frontiers in Neurology (Jun 2024)
Managing intraoperative rupture of internal carotid pseudoaneurysms during endoscopic transnasal optic canal decompression: a case report
- Zeran Yu,
- Zeran Yu,
- Zeran Yu,
- Zeran Yu,
- Junhui Qi,
- Junhui Qi,
- Junhui Qi,
- Lei Wang,
- Lei Wang,
- Lei Wang,
- Xiang Yang,
- Zhengqiao Liu,
- Zhengqiao Liu,
- Zhengqiao Liu,
- Xu Chen,
- Xu Chen,
- Xu Chen,
- Hongling Xu,
- Hongling Xu,
- Hongling Xu,
- Yajie Li,
- Yajie Li,
- Yajie Li,
- Yuyun Chen,
- Yuyun Chen,
- Yuyun Chen,
- Chengguo Dai,
- Chengguo Dai,
- Chengguo Dai,
- Zhen Gu,
- Zhen Gu,
- Zhen Gu
Affiliations
- Zeran Yu
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Zeran Yu
- Department of Neurosurgery, Beijing Tiantan Hospital Yunnan, Kunming, China
- Zeran Yu
- The Center of Stroke, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Zeran Yu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
- Junhui Qi
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Junhui Qi
- Department of Neurosurgery, Beijing Tiantan Hospital Yunnan, Kunming, China
- Junhui Qi
- The Center of Stroke, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Lei Wang
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Lei Wang
- Department of Neurosurgery, Beijing Tiantan Hospital Yunnan, Kunming, China
- Lei Wang
- The Center of Stroke, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Xiang Yang
- Department of Obstetrics, The First People’s Hospital of Yunnan, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
- Zhengqiao Liu
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Zhengqiao Liu
- Department of Neurosurgery, Beijing Tiantan Hospital Yunnan, Kunming, China
- Zhengqiao Liu
- The Center of Stroke, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Xu Chen
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Xu Chen
- Department of Neurosurgery, Beijing Tiantan Hospital Yunnan, Kunming, China
- Xu Chen
- The Center of Stroke, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Hongling Xu
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Hongling Xu
- Department of Neurosurgery, Beijing Tiantan Hospital Yunnan, Kunming, China
- Hongling Xu
- The Center of Stroke, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Yajie Li
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Yajie Li
- Department of Neurosurgery, Beijing Tiantan Hospital Yunnan, Kunming, China
- Yajie Li
- The Center of Stroke, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Yuyun Chen
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Yuyun Chen
- Department of Neurosurgery, Beijing Tiantan Hospital Yunnan, Kunming, China
- Yuyun Chen
- The Center of Stroke, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Chengguo Dai
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Chengguo Dai
- Department of Neurosurgery, Beijing Tiantan Hospital Yunnan, Kunming, China
- Chengguo Dai
- The Center of Stroke, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Zhen Gu
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Zhen Gu
- Department of Neurosurgery, Beijing Tiantan Hospital Yunnan, Kunming, China
- Zhen Gu
- The Center of Stroke, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- DOI
- https://doi.org/10.3389/fneur.2024.1382793
- Journal volume & issue
-
Vol. 15
Abstract
BackgroundEndoscopic transnasal optic canal decompression is widely used in the treatment of traumatic optic neuropathy (TON) following head and craniofacial trauma. Intraoperative hemorrhage is a catastrophic surgical complication during optic canal decompression.Case descriptionWe present two cases of patients with TON who suffered unexpected intra-operative massive bleeding during endoscopic transnasal optic canal decompression. After intraoperative hemostasis was achieved, emergent cerebral angiograms demonstrated the formation of internal carotid pseudoaneurysms, which were immediately embolized with coils combined with or without Onyx with balloon assistance. One of these cases was also complicated by a postoperative cerebrospinal fluid leak, which failed to be treated with lumbar drainage but was successfully repaired with endoscopic transnasal surgery.ConclusionThe intra-operative rupture of ICA pseudoaneurysm is a rare but catastrophic complication in TON patients. Intraoperative massive bleeding indicates rupture of ICA pseudoaneurysm. Postoperative emergency angiography and endovascular therapy should be arranged to evaluate and repair the cerebral vascular injury. Endoscopic trans-nasal surgery repairing CSF leaks resistant to lumbar drainage could be efficient and safe following pseudoaneurysm embolization.
Keywords
- pseudoaneurysm
- intraoperative hemorrhage
- traumatic optic neuropathy
- endoscopic transnasal optic canal decompression
- endovascular embolization
