P.085 Perioperative endovascular procedure utilization in transsphenoidal surgery patients at two tertiary-care academic centres. (June 2019)

• Record Type: Journal Article
• Authors: Huynh, TJ; Cusimano, M; Clarke, DB; Weeks, A; Marotta, TR; Maloney, WJ; Aldakkan, A; Bharatha, A
• Is Part Of: Canadian journal of neurological sciences. Volume 46(2019)Supplement 1
• Page Start: S36
• Page End: S36
• Publication Date: 2019-06
• Subjects: Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Electronic journals; 616.8
• DOI: 10.1017/cjn.2019.182
• Languages: English
• ISSNs: 0317-1671

Abstract

Abstract : Background: Utilization of endovascular procedures in the perioperative management of patients undergoing transsphenoidal surgery is uncommon but plays a critical role in preventing and treating potentially life-threatening vascular complications. Methods: We performed a retrospective review of all patients over a 10-year period who underwent transsphenoidal surgery at two tertiary-care institutions and identified all pre-operative and post-operative endovascular procedures performed. Results: 18 perioperative endovascular procedures were performed including 9 pre- and 9 post-operative. Pre-operative procedures included balloon-test occlusion (n=4), aneurysm coiling (n=4), and parent artery occlusion (n=1). One aneurysm coiling was complicated by coil migration requiring coil retrieval with a snare device and one balloon-test occlusion was complicated by pituitary apoplexy. Pituitary apoplexy following balloon-test occlusion has not been reported and the potential pathophysiology is reviewed. Post-operative procedures included embolization for epistaxis (n=2) and embolization with or without parent artery sacrifice for carotid and anterior cerebral artery vascular injury (n=7). Arterial vascular injury was managed with coil embolization and/or with detachable balloons. Review of anatomical features predisposing to vascular injury are discussed. Conclusions: Patients undergoing transsphenoidal surgery should be managed with a multidisciplinary team ensuring that endovascular treatment options are made available during the perioperative period.