Catastrophic Internal Carotid Artery Injury in Endoscopic Transsphenoidal Surgery: a Case Report

Abstract

Internal carotid artery (ICA) injury during endoscopic transsphenoidal surgery (ETSS) is a rare but critical complication. A 69-year-old man underwent ETSS for a nonfunctioning pituitary macroadenoma. He had intraoperatively severe bleeding that occurred from a suspected rupture of the right paraclinoid ICA, resulting in 3500 ml of blood loss and hypotension. After controlled bleeding, he was transferred to the angiographic suite, where cerebral angiography confirmed the injury. Definitive management involved ICA balloon sacrifice to stop the bleeding. Postoperatively, the patient was sedated in the intensive care unit for three days to ensure vascular stability. Sedation was managed with propofol. The patient was extubated on the third day with no significant neurological deficits except for right visual field loss. This case shows the critical role of a coordinated multidisciplinary approach in managing ICA injury during ETSS, demonstrating how prompt action can minimize complications.