Nasopharyngeal muscle patch for the management of internal carotid artery injury in endoscopic endonasal surgery

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OBJECTIVE

Injury to the internal carotid artery (ICA) is the most critical complication of endoscopic endonasal skull base surgery. Packing with a crushed muscle graft at the injury site has been an effective management technique to control bleeding without ICA sacrifice. Obtaining the muscle graft has typically required access to another surgical site, however. To address this concern, the authors investigated the application of an endonasally harvested longus capitis muscle patch for the management of ICA injury.

METHODS

One colored silicone-injected anatomical specimen was dissected to replicate the surgical access to the nasopharynx and the stepwise dissection of the longus capitis muscle in the nasopharynx. Two representative cases were selected to illustrate the application of the longus capitis muscle patch and the relevance of clinical considerations.

RESULTS

A suitable muscle graft from the longus capitis muscle could be easily and quickly harvested during endoscopic endonasal skull base surgery. In the illustrative cases, the longus capitis muscle patch was successfully used for secondary prevention of pseudoaneurysm formation following primary bleeding control on the site of ICA injury.

CONCLUSIONS

Nasopharyngeal harvest of a longus capitis muscle graft is a safe and practical method to manage ICA injury during endoscopic endonasal surgery.

ABBREVIATIONS EES = endoscopic endonasal surgery; ICA = internal carotid artery.
Article Information

Contributor Notes

Correspondence Paul A. Gardner: UPMC Center for Cranial Base Surgery, Pittsburgh, PA. gardpa@upmc.edu.INCLUDE WHEN CITING Published online October 18, 2019; DOI: 10.3171/2019.7.JNS191370.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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