Emergency management of intraoperative internal carotid artery rupture during endoscopic endonasal resection of a sinonasal tumor:a case report
Tang Yurong
Ma Shuai
Zhang Junjie
Li Fan
Abstract：Endoscopic endonasal surgery is a common approach for sinonasal tumors.However,intraoperative injury to the internal carotid artery(ICA)represents an extremely dangerous complication of such procedures.Although the conse-quences of intraoperative ICA rupture are severe,its incidence is relatively low,ranging from 0%to 0.1%.This article reports a case of a 38-year-old female patient who underwent endoscopic endonasal resection for a sphenoid sinus tumor.After gross total resection of the tumor,bleeding from the ICA progressed from oozing to massive hemorrhage,with an estimated blood loss of approximately 2000 mL.Following successful hemostasis by packing with iodoform gauze,emergency digital subtraction angi-ography(DSA)was performed,confirming rupture of the cavernous segment of the left ICA.The defect was then sealed using a Willis covered stent,followed by skull base reconstruction.At the 9-month follow-up,the patient recovered well.Follow-up magnetic resonance angiography(MRA)showed patency of the cavernous segment of the left ICA,and follow-up MRI revealed no tumor recurrence.This case suggests that for intraoperative ICA rupture,the defect must be managed urgently,followed by reconstruction of the blood flow pathway using a covered stent or a high-flow bypass to avoid complications from distal ischemic infarction.
Keywords：sinonasal tumorsendoscopic endonasal resectionintraoperative internal carotid artery ruptureWillis covered stent
Publication Date：2025-12-25
Online Publishing Date：2026-02-02(First online date of this platform, not the publication date of the document)
Pages：3( 766-768 )