| ORIGINAL ARTICLE
|Year : 2022 | Volume
| Issue : 4 | Page : 1580--1589
An Institutional Experience and Literature Review on Iatrogenic Major Vascular Injury in Neurosurgery: Proposal of a Management Algorithm
Bhawan Nangarwal1, Kamlesh Singh Bhaisora1, Deepak Khatri1, Ashish Sharma1, Vivek Singh2, Vedprakash Maurya1, Pawan Verma1, Jayesh Sardhara1, Kuntal Kanti Das1, Anant Mehrotra1, Arun Kumar Srivastava1, Awadhesh Kumar Jaiswal1, Sanjay Behari1
1 Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India
2 Department of Intervention Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India
Background: Major vessel injury is among the most dreaded complications of any neurosurgical procedure. Once intraoperatively tamponaded, it can present in the form of pseudoaneurysm, dissecting aneurysm or complete occlusion of vessel. These injuries are often associated with very high morbidity and mortality. The literature available on this topic is limited and our understanding remains limited.
Objective: In this article, we present our surgical experience with iatrogenic aneurysms and present a review of literature.
Methods and Material: We conducted a retrospective analysis of all patients with major vessel injury during surgery from a prospectively maintained database from January 2012 to February 2020.
Results: A total of 15 patients developed iatrogenic aneurysms following a major vessel injury during various neurosurgical procedures. The most common vessel injured was vertebral artery (n = 9) in craniovertebral junction (CVJ) anomalies and ossification of posterior longitudinal ligament (OPLL) followed by internal carotid artery injury (n = 5) in sellar and parasellar pathologies. One patient developed basilar artery injury during endoscopic third ventriculostomy (ETV). Eight patients had pseudoaneurysm and seven had dissecting aneurysm with or without complete thrombosis of the involved artery. A total of two patients died after vascular injury and remaining thirteen patients survived and discharged.
Conclusions: The adage “prevention is better than cure” applies most aptly in such cases. Any major vessel injury should be followed by immediate angiography and subsequent early management. The endovascular management is more favorable as these aneurysms are difficult to clip due to the absence of a neck and fragile wall.
Kamlesh Singh Bhaisora
Associate Professor, Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow – 226 014, UP
Source of Support: None, Conflict of Interest: None
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