• Chang Ki Hong, Joonho Byun, Wonhyoung Park, Young-Hoon Kim, Jung Cheol Park, Jae Sung Ahn, and Jeong Hoon Kim.
• Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
• World Neurosurg. 2022 Jul 1; 163: e230-e237.

ObjectiveInternal carotid artery (ICA) injury during transsphenoidal surgery is a rare but serious complication. We analyzed a series of ICA injuries that occurred during a transsphenoidal approach to suggest an optimal management strategy.MethodsBetween January 2015 and May 2020, we enrolled 10 cases of ICA injury at our institution.ResultsAmong the 10 patients enrolled, 5 had pituitary adenoma, 2 had craniopharyngioma, and 1 each had skull base chondrosarcoma, tuberculum sellae meningioma, and nasopharyngeal cancer; 4 were revision surgery cases. The cavernous segment of the ICA was the most commonly injured area. The most common reason for ICA injury was a drill injury at the sellar floor opening. A direct repair was performed using a clip in only 1 patient. In the others, bleeding control of the injured ICA was achieved by packing multiple cotton pads. After angiography, 6 patients underwent immediate endovascular sacrifice of the injured ICA. In 3 patients who showed poor collateral flow from the anterior communicating and posterior communicating arteries, revascularization surgery was performed before endovascular trapping. After 6 postoperative months, 6 patients showed favorable functional outcomes, and 4 patients showed poor functional outcomes.ConclusionsPrompt control of bleeding, endovascular management of injured ICA, and consideration of revascularization surgery based on collateral flow may prevent catastrophic neurological sequelae.Copyright © 2022 Elsevier Inc. All rights reserved.

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