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J Neurol Surg B Skull Base
DOI: 10.1055/a-2065-9404
Original Article

Endoscopic Repair of Internal Carotid Artery Injury with a Lateral Tongue Muscle Patch Graft: Novel Technique and Literature Review

Nikita Chapurin 
1   Division of Rhinology/Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, United States
2   Division of Rhinology/Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Rahul K. Sharma
2   Division of Rhinology/Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Madelyn N. Stevens
2   Division of Rhinology/Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Esther Kim
3   Department of Otolaryngology, Walter Reed National Military Medical Center, Bethesda, Maryland, United States
,
Justin H. Turner
2   Division of Rhinology/Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Paul T. Russell
2   Division of Rhinology/Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
› Author Affiliations Funding J.H.T. is supported by NIH R21 AI142321 and NIH R01 AG065550. These funding organizations did not contribute to the design or conduct of this study; collection, management, analysis, or interpretation of the data; preparation, review, approval, or decision to submit this manuscript for publication. There are no relevant financial disclosures for any of the other authors.
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Abstract

Objectives Iatrogenic injury to the internal carotid artery (ICA) is one of the most catastrophic complications of endoscopic sinus and skull base surgery. Previous research has shown that packing with a crushed muscle graft at the injury site can be an effective management technique to control bleeding and prevent the need for ICA sacrifice. Here, we describe a novel and readily available repair donor site—an autologous lateral tongue muscle patch.

Design Three representative cases of a successful repair of ICA injuries using a lateral tongue muscle patch are included in this study. The graft measured approximately 2 × 3 cm and was taken from the lateral intrinsic tongue musculature. We describe the harvest of the graft, its advantages, and the details of operative repair.

Results The lateral tongue provides a large and readily accessible source of muscle within the surgical field that can be quickly harvested during an endoscopic procedure. For the first case, an expanding parasellar ICA pseudoaneurysm was managed with a tongue muscle patch and nasal packing. In the second case, a cavernous ICA injury was sustained during craniopharyngioma resection. Case three involved an ICA injury during endonasal debridement of invasive fungal rhinosinusitis. None of the patients required embolization or neurovascular stenting. Postoperative angiograms and serial computed tomography angiograms showed complete resolution of the pseudoaneurysm, and the patients continued to do well at least 1 year after repair.

Conclusions Lateral tongue muscle graft is an effective and efficient method to manage ICA injuries during endoscopic endonasal surgery. Advantages include the speed of harvest, donor site being readily accessible in the surgical field, and low donor site morbidity. It should be added to the repertoire of possible donor sites for addressing catastrophic sinonasal bleeding.

Keywords

internal carotid artery - injury - skull base surgery - muscle patch - tongue - repair - endoscopic

This work was presented as a podium presentation at the North American Skullbase Annual Meeting in Phoenix, AZ on Feb 18, 2022.




Publication History

Received: 24 December 2022

Accepted: 27 March 2023

Accepted Manuscript online:
30 March 2023

Article published online:
19 April 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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