Journal article
Carotid-Cavernous Fistula After Transsphenoidal Surgery: A Rare but Challenging Complication.
- Cossu G Department of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland. Electronic address: giulia.cossu@chuv.ch.
- Al-Taha K Department of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland.
- Hajdu SD Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland.
- Daniel RT Department of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland.
- Messerer M Department of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland.
- 2019-11-13
Published in:
- World neurosurgery. - 2020
Carotid artery injury
Carotid-cavernous fistula
Coiling
Embolization
Endoscopy
Endovascular treatment
Transsphenoidal surgery
Adenoma
Aged
Angiography, Digital Subtraction
Carotid-Cavernous Sinus Fistula
Cerebral Angiography
Embolization, Therapeutic
Endovascular Procedures
Female
Growth Hormone-Secreting Pituitary Adenoma
Humans
Magnetic Resonance Imaging
Neuroendoscopy
Postoperative Complications
Sphenoid Bone
English
BACKGROUND
Carotid-cavernous fistula (CCF) is a rare complication after transsphenoidal surgery.
METHODS
The aim of this article is to report a case of CCF after the endoscopic resection of a growth hormone secreting pituitary microadenoma, and to discuss and review all the cases of CCF secondary to transsphenoidal procedures described in literature.
RESULTS
A patient aged 74 years was operated for a growth hormone pituitary microadenoma through an endoscopic transsphenoidal surgery. During the procedure, a copious bleeding from the left cavernous sinus was managed with hemostatic material. A direct CCF was diagnosed and managed with transvenous and transarterial coiling. A complete exclusion of the fistula was possible, and the patency of the internal carotid artery was maintained. A total of 9 other cases have been reported. A transsphenoidal approach was performed for sellar tumors in 6 cases, and for chronic sinusitis in 2 cases. In 7 cases, intraoperative hemorrhage was reported, which could be controlled in 5 cases. The postoperative diagnosis of CCF was immediate in 5 cases. Patients presented with persistent bleeding after nasal unpacking or later with chemosis and proptosis. Cerebral angiography was the gold standard for the diagnosis. Eight cases were successfully treated through endovascular techniques with no recurrence observed at follow-up (mean of 15 months). No major neurologic complications were observed.
CONCLUSIONS
CCF should be suspected with every abnormal bleeding after transsphenoidal surgeries, even when the symptoms are mild. Diagnostic arteriography and endovascular treatment represent the mainstay of the management, and an early diagnosis strongly improves the prognosis.
Carotid-cavernous fistula (CCF) is a rare complication after transsphenoidal surgery.
METHODS
The aim of this article is to report a case of CCF after the endoscopic resection of a growth hormone secreting pituitary microadenoma, and to discuss and review all the cases of CCF secondary to transsphenoidal procedures described in literature.
RESULTS
A patient aged 74 years was operated for a growth hormone pituitary microadenoma through an endoscopic transsphenoidal surgery. During the procedure, a copious bleeding from the left cavernous sinus was managed with hemostatic material. A direct CCF was diagnosed and managed with transvenous and transarterial coiling. A complete exclusion of the fistula was possible, and the patency of the internal carotid artery was maintained. A total of 9 other cases have been reported. A transsphenoidal approach was performed for sellar tumors in 6 cases, and for chronic sinusitis in 2 cases. In 7 cases, intraoperative hemorrhage was reported, which could be controlled in 5 cases. The postoperative diagnosis of CCF was immediate in 5 cases. Patients presented with persistent bleeding after nasal unpacking or later with chemosis and proptosis. Cerebral angiography was the gold standard for the diagnosis. Eight cases were successfully treated through endovascular techniques with no recurrence observed at follow-up (mean of 15 months). No major neurologic complications were observed.
CONCLUSIONS
CCF should be suspected with every abnormal bleeding after transsphenoidal surgeries, even when the symptoms are mild. Diagnostic arteriography and endovascular treatment represent the mainstay of the management, and an early diagnosis strongly improves the prognosis.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.wneu.2019.10.194
- PMID 31712112
- Persistent URL
- https://sonar.ch/global/documents/278010
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