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CC BY-NC-ND 4.0 · J Neurol Surg Rep 2021; 82(04): e43-e48
DOI: 10.1055/s-0041-1735284
Original Article

Combined Pipeline Embolization Device with Endoscopic Endonasal Fascia Lata/Muscle Graft Repair as a Salvage Technique for Treatment of Iatrogenic Carotid Artery Pseudoaneurysm

Ann Liu 
1   Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Jordina Rincon-Torroella
1   Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Matthew T. Bender
1   Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, United States
2   Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, United States
,
Cameron G. McDougall
1   Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Anthony P. Tufaro
3   Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Maryland, United States
4   Division of Plastic Surgery, Department of Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
,
Nyall R. London Jr
5   Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Alexander L. Coon
1   Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, United States
6   Department of Neurosurgery, Carondelet Neurological Institute, Tucson, Arizona, United States
,
Douglas D. Reh
5   Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland, United States
7   Department of Otolaryngology-Head and Neck Surgery, Greater Baltimore Medical Center, Baltimore, Maryland, United States
,
Gary L. Gallia
1   Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, United States
5   Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland, United States
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Abstract

The incidence of internal carotid artery (ICA) injury associated with endoscopic endonasal approaches to the pituitary is less than 1%. While parent vessel sacrifice has historically been the choice of treatment, vessel-preserving endovascular techniques have been reported. Although flow diversion offers endoluminal reconstruction, its major limitation is the delay in obtaining complete occlusion. We describe the use of a combined Pipeline embolization device (PED) with endoscopic endonasal repair using a fascia lata/muscle graft to treat an iatrogenic ICA pseudoaneurysm and report long-term radiographic follow-up. Further investigation into the utility of directed endoscopic endonasal repair of iatrogenic pseudoaneurysms initially treated with PED is necessary, especially given the need of post-PED anticoagulation and the rate of permanent neurological deficit after ICA sacrifice.

Keywords

endoscopic endonasal - fascia lata - iatrogenic carotid injury - muscle graft - pituitary adenoma - Pipeline embolization - pseudoaneurysm

Disclosures

Dr. Alexander L. Coon is a proctor for the Woven Endobridge (WEB) device (Sequent Medical); a proctor for the Surpass device (Stryker Neurovascular), and a consultant for Stryker Neurovascular; a proctor for the PED (Medtronic Neurovascular) and a consultant for Medtronic; a proctor for the FRED device (MicroVention) and consultant for MicroVention; and a consultant for InNeuroCo. Dr. Nyall R. London holds stock in Navigen Pharmaceuticals and was a consultant for Cooltech Inc., both of which are unrelated to the present manuscript. Dr. Cameron G. McDougall is a consultant for Microvention and Medtronic.


Source of Financial Support and Industry Affiliations

None.




Publication History

Received: 15 September 2020

Accepted: 14 January 2021

Article published online:
01 December 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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