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- MakaleAçık Erişim2025Scopus SJRQ2Management of Major Arterial Injuries: A Critical Complication of Endoscopic Endonasal Surgery
Emengen, Atakan; Yilmaz, Eren; Gokbel, Aykut; Uzuner, Ayse; Cakir, Ozgur; Ciftci, Ercument; Ozsoy, Bedrettin; Ergen, Anil; Caklili, Melih; Cabuk, Burak
BACKGROUND AND OBJECTIVES:Endoscopic endonasal surgery (EES) is the preferred approach for treating sellar and parasellar lesions due to its panoramic view and detailed anatomical definition. This study aims to review major arterial injuries during EES, a rare but critical complication associated with high mortality and morbidity rates.METHODS:A retrospective analysis was conducted, including 15 patients from 5640 EES procedures performed between August 1997 and February 2024 at in our center/Department of Neurosurgery. The study focuses on perioperative and postoperative management strategies, highlighting the use of oxidized regenerated cellulose (Surgicel (R))/gelatin-thrombin matrix (Floseal (R)) and multidisciplinary collaboration to achieve hemostasis.RESULTS:The incidence of major arterial injury was 0.2%, with a mean patient age of 38.4 years and a female-to-male ratio of 10:5. The most common tumors were adenomas (n = 7) and chordomas (n = 5). The most commonly bleeding arteries in 6 patients each are the cavernous segment of the internal carotid artery and the paraclival carotid artery. Low-flow bleeding was observed in 10 of our patients, while high-flow bleeding was seen in 5 patients, 4 of whom were recurrent cases (P < .05). In 3 patients with high-flow bleeding from segments of the carotid artery, digital subtraction angiography was performed for stent placement or coil embolization, while in 1 patient with high-flow bleeding, digital subtraction angiography was used for monitoring cerebral blood flow. One of our patients died of a myocardial infarction at the 14th month of follow-up and 1 of our patients developed left-hemiparesis.CONCLUSION:The study underscores the importance of preoperative planning, surgical expertise, and multidisciplinary teamwork in managing major arterial injuries during EES. The authors advocate for the development of standardized treatment algorithms to improve outcomes in these patients. The findings contribute to the limited literature on managing internal carotid artery injuries in EES, emphasizing the need for ongoing research and algorithm development.
AtıfWoS2OpenAlex4İncele - Derleme MakaleAçık Erişim2025Scopus SJRQ2Purely endoscopic endonasal resection of extracranial trigeminal schwannomas: a descriptive systematic review and institutional case series
Yilmaz, Eren; Emengen, Atakan; Uzuner, Ayse; Ozsoy, Bedrettin; Gokbel, Aykut; Anik, Ihsan; Ceylan, Savas
Background: Trigeminal schwannomas (TSs) are uncommon, benign tumors that arise from the trigeminal nerve. They can spread to the middle cranial fossa, posterior fossa, and extracranially (pterygopalatine fossa (PPF), infratemporal fossa, orbita). Among these, extracranial involvement is the least frequent. Before the advent of endoscopic techniques, these tumors were primarily removed using conventional microsurgical approaches. Due to both the rarity of extracranial localization and the increasing use of endoscopic techniques in suitable cases, reports of TSs with extracranial involvement treated via a purely endoscopic endonasal approach (EEA) remain limited, typically appearing as case reports or a small subset within larger case series. This study systematically reviews the literature on extracranial TSs managed exclusively with EEA and presents two illustrative cases from our institution. Methods: A systematic search of the PubMed database was performed in accordance with PRISMA guidelines to identify studies that utilized a purely EEA for extracranial TS cases. Additionally, a retrospective review of 6118 EEA procedures conducted at our institution identified two patients with histopathologically confirmed extracranial TSs. Clinical presentation, surgical approach, outcomes, and complications were analyzed. Results: A total of 147 records were identified through database searches and reference lists. After removing duplicate records, 144 full-text articles were assessed for eligibility. Of these, 124 studies were excluded with justification, resulting in 23 studies being included in the review. When combined with our institutional cases, data from a total of 52 patients were analyzed. Facial numbness was the most common presenting symptom (70.5 %). The mean tumor diameter was 38.6 +/- 13.3 mm, and the gross total resection rate was 93.1 %. In our cases, both patients successfully underwent tumor resection via EEA without postoperative neurological deficits. Conclusions: EEA provides a direct, minimally invasive route for managing extracranial TSs while reducing the morbidity associated with transcranial approaches. Although optimal for purely extracranial tumors, lesions extending into the middle or posterior fossa may require a combined approach. Therefore, individualized surgical planning is essential for achieving optimal outcomes in TS management.
AtıfWoS1OpenAlex1İncele