内窥镜鼻内手术中颈内动脉损伤:术中磁共振成像的价值。

Neurosurgery practice Pub Date : 2024-01-11 eCollection Date: 2024-03-01 DOI:10.1227/neuprac.0000000000000073
Abdulrazag Ajlan, Emad M Babateen, Ashwag Alqurashi
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引用次数: 0

摘要

背景和重要性:颈内动脉损伤是内镜下鼻内手术的严重并发症。我们报告一例完全切除斜坡脊索瘤,尽管术中ICA损伤内镜鼻内手术。术中MRI (iMRI)定位出血部位,确认切除程度及远端损伤部位ICA通畅,排除术中缺血。临床表现:一名16岁的女孩表现为右侧面部感觉异常,并被诊断为以斜坡为中心的大面积侵入性颅底溶解性病变。患者神经学检查正常,除右侧面部感觉减退外。在肿瘤切除过程中,ICA门旁段发生大出血,使用止血药物直接加压。肿瘤部分切除,未见明显的缺血性损伤征象,iMRI观察到ICA损伤部位远端有通畅血流。这些发现有助于决定进行手术和完全切除。术后立即进行的血管造影显示假性动脉瘤,并成功地用线圈栓塞。出院后无新的神经功能缺损,术后影像学显示完全切除,损伤的ICA分布无缺血性脑卒中迹象。结论:虽然不常用于检测颅底病变,但iMRI在我们的脊索瘤病例中是有价值的,并使外科团队能够进行完整的手术切除。它提供了损伤和可能的并发症的实时评估。因此,对于高危颅底ICA损伤,应考虑采用iMRI。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Internal Carotid Artery Injury in Endoscopic Endonasal Surgery: The Value of Intraoperative Magnetic Resonance Imaging.

Background and importance: Internal carotid artery (ICA) injury is a devastating complication of endoscopic endonasal surgery. We report a case of completely resected clival chordoma using endoscopic endonasal surgery despite intraoperative ICA injury. Intraoperative MRI (iMRI) was used to localize the bleeding site, confirm resection degree and ICA patency distal to the injury site, and rule out intraoperative ischemia.

Clinical presentation: A 16-year-old girl presented with right-sided facial paresthesia and was diagnosed with a large, invasive skull base lytic lesion centered in the clivus. The patient's neurological examination was normal, except for decreased sensation on the right side of the face. During tumor resection, massive bleeding occurred from the ICA paraclival segment, which was by applying direct pressure using hemostatic agents. Partial tumor resection, no clear signs of ischemic injury, and a patent flow distal to the ICA injury site were observed using iMRI. These findings helped in the decision to proceed with surgery and complete gross total resection. Postoperative angiography immediately performed after surgery revealed a pseudoaneurysm that was successfully embolized with coils. After discharge with no new neurological deficits, the postoperative imaging showed complete resection and no evidence of ischemic stroke in the injured ICA distribution.

Conclusion: Although not commonly used to detect skull base lesions, iMRI was valuable in our chordoma case and enabled the surgical team to proceed with a complete surgical resection. It provided real-time evaluation of the injury and possible complications. Thus, iMRI should be considered for high-risk skull base ICA injuries.

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