Pseudoaneurysm of Internal Carotid Artery following Endoscopic Endonasal Pituitary Surgery requiring Endovascular Treatment in an Acromegalic Patient with a Difficult Airway

Joanna S. Rodrigues; Ankit Gupta; Anil Parakh

doi:10.1055/s-0039-1692736

Journal of Neuroanaesthesiology and Critical Care, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2020; 7(01): 34-37
DOI: 10.1055/s-0039-1692736

Case Report

Pseudoaneurysm of Internal Carotid Artery following Endoscopic Endonasal Pituitary Surgery requiring Endovascular Treatment in an Acromegalic Patient with a Difficult Airway

Joanna S. Rodrigues

¹Department of Anaesthesia, Global Hospitals, Mumbai, Maharashtra, India

,

Ankit Gupta

¹Department of Anaesthesia, Global Hospitals, Mumbai, Maharashtra, India

,

Anil Parakh

¹Department of Anaesthesia, Global Hospitals, Mumbai, Maharashtra, India

› Institutsangaben

Abstract

A pituitary tumor scheduled for surgical excision can eventuate with a myriad of challenges. A 49-year-old acromegalic patient was admitted to our hospital for trans-nasal trans-sphenoidal pituitary surgery. Magnetic resonance imaging (MRI) of his brain revealed a well-defined lesion involving right half of the anterior lobe of pituitary. In the operating room, we encountered difficulty in management of the airway. The trachea could be intubated using fiberoptic bronchoscope via a proseal laryngeal mask airway after five attempts of failed intubation. Intraoperatively, the right internal carotid artery (ICA) was injured during excision of lateral part of the tumor with a blood loss of 3.5 L. Adenosine use to aid hemostasis was unsuccessful. Endovascular coil embolization was done to treat the pseudoaneurysm developed in the right ICA, to restore the blood flow. During this process, the patient developed medial rectus palsy and ptosis in the right eye, which improved gradually. The above amalgamation of maladies commanded an integrated and well-coordinated team approach to manage the catastrophic complications.

Keywords

airway management - endotracheal intubation - pituitary adenoma - acromegaly - pseudoaneurysm

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Referenzen

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