====== Internal carotid artery injury after transsphenoidal approach ======


[[Internal carotid artery injury]] is a potentially lethal [[complication]] in [[transsphenoidal approach]]  for [[pituitary]] [[lesion]]s. The [[intercarotid distance]] (ICD) is thus a major parameter, determining the width of the surgical corridor.

Unrelated pathology may complicate a transsphenoidal approach: rare, e.g. a [[parasellar]] [[aneurysm]].

Carotid artery rupture: rare. May occur intraoperatively or in a delayed fashion after surgery, often ≈ day 10 post-op (due to the breakdown of fibrin around carotid, or possibly due to rupture of a [[pseudoaneurysm]] created at surgery).
----
If a [[pseudoaneurysm]] or site of injury is identified angiographically, it must be eliminated before a potentially lethal hemorrhage; accomplished either by endovascular techniques or by surgical
[[trapping]] with [[clip]]s above and below.

===== Case reports =====

Haley et al. reported a case of coil [[migration]] into the [[oropharynx]] five years after treatment of a left internal carotid [[pseudoaneurysm]] following abandoned [[transsphenoidal]] resection of a pituitary [[macroadenoma]]. Eight other cases were found on literature review, with coil migration occurring between 2 and 120 months often after a history of [[transsphenoidal surgery]]. The majority of these were treated with trimming in a day case setting. This report highlights the need for careful extended follow up when a pseudoaneurysm forms with a concurrent skull base deficit
((Haley M, Kumaria A, Lenthall R, McConachie N, Smith S, Dow G. Coughing on the 
coil; a case report and literature review of eight cases of endovascularly
treated ICA pseudoaneurysms with coil migration into the oropharnyx. Br J
Neurosurg. 2020 Jan 29:1-3. doi: 10.1080/02688697.2020.1716944. [Epub ahead of
print] PubMed PMID: 31994916.)).

===== Unclassified =====
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