The Laryngoscope
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Since the advent of endonasal skull base surgery, internal carotid artery (ICA) injury has been considered the most dramatic and challenging intraoperative complication. A large vascular injury creates an immediately challenging surgical scenario with rapid blood loss that may result in exsanguination of the patient. Recently we have developed an animal model of the endoscopic, endonasal vascular injury. We describe important surgical steps required in managing the surgical field during a catastrophic vascular event. ⋯ Controlling the endoscopic endonasal surgical field during vascular injuries relies on the cooperation of the surgical team and a step-based approach including careful endoscopic maneuvering within the nasal corridor, and appropriate suction selection and positioning with respect to the endoscope.