Neuroanesthesiological management of carotid rupture in the endoscopic endonasal approach to the skull base

The medical literature on perioperative anesthesiological care of carotid artery rupture in endoscopic endonasal skull base surgery is practically non-existent. This type of neurovascular injury combines a relatively low incidence with a non-negligible morbidity and mortality. It also requires coordinated multidisciplinary treatment to minimize brain injury induced by inadequate therapeutic management.

This article presents a series of clinical recommendations and an algorithm for perioperative neuroanesthesiological care of this serious complication.

To prepare them, a group consisting of five neuroanesthesiologists, a neurosurgeon, an otorhinolaryngologist, a neuroradiologist, and a haematologist reviewed the limited literature on anesthesiological care of this complication. In addition, they adapted anesthesiological care in neurosurgical scenarios similar to the treatment of carotid artery rupture during endoscopic skull base surgery.