J Neurol Surg B Skull Base 2020; 81(S 01): S1-S272
DOI: 10.1055/s-0040-1702386
Oral Presentations
Georg Thieme Verlag KG Stuttgart · New York

Intraoperative Protocol for the Management of Carotid Artery Injury during Endoscopic Endonasal Surgery

Zachary Kassir
1   University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
,
Carl H. Snyderman
2   UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
,
Paul A. Gardner
2   UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
,
Eric W. Wang
2   UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
,
Georgios A. Zenonos
2   UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, United States
› Author Affiliations
Further Information

Publication History

Publication Date:
05 February 2020 (online)

 
 

    Background: Intraoperative injury to a major vessel, most commonly the internal carotid artery (ICA), during endoscopic endonasal surgery, is a serious adverse event that is associated with significant morbidity and risk of mortality. At least 20% of surveyed surgeons have experienced ICA injury.

    Objectives: The primary objectives of the study are to: (1) Assess knowledge of management of intraoperative ICA injury; (2) Develop intraoperative protocol for surgical team.

    Methods: A 14-question survey of skull base surgeons (course participants and Web site) was performed to assess knowledge of management of intraoperative carotid artery injury. Responses were then used to develop a teaching curriculum for skull base surgeons. Members of the surgical team were interviewed to determine roles and responsibilities intraoperatively. Prior experiences with ICA injury were reviewed using root-cause analysis to identify contributing factors and errors in management.

    Results: There were 71 respondents for the knowledge survey. Correct responses to individual questions ranged from 6 to 87%. Areas identified for education included risk factors for injury, neurological monitoring, surgical management, angiographic management, equipment, and functions of surgical team members. Review of prior ICA injuries revealed inconsistent practices and poor communication regarding roles of team members. An educational curriculum was constructed based on responses. An intraoperative protocol that is inclusive of all team members was developed based on interviews and past experiences with ICA injury as well as a review of the literature. A surgical simulation training activity is proposed that incorporates all of these elements.

    Conclusion: There is a need for education and enhanced training of skull base surgeons and the operative team to improve management of intraoperative ICA injury. We believe that our educational curriculum can help to meet this need.


    #

    No conflict of interest has been declared by the author(s).