2025 Proffered Presentations
S355: PERFUSION-BASED CADAVERIC MODEL USING AN ENDOVASCULAR BALLOON CATHETER TO MANAGE ICA INJURY VIA AN ENDOSCOPIC ENDONASAL APPROACH.
Dilan Ozaydin, MD; Vera Vigo, MD, PhD; Limin Xiao, MD; Joaquin Chuang, MD; Juan Carlos Fernandez Miranda, MD; Stanford
Introduction: Internal carotid artery (ICA) injury during endoscopic endonasal surgery (EEC) is a severe complication, with reported injury rates ranging from 0.3% to 9%. Due to the rarity and critical nature of this complication achieving optimal training is difficult. Instead, cadaver models, such as the perfusion-based model developed by Aboud and colleagues, provide a vital simulation of real-life conditions, including arterial blood flow and human anatomy. Our study aims to evaluate the effectiveness of using an endovascular balloon catheter to manage ICA injuries during endoscopic endonasal surgery in a cadaver model. Specifically, we tested the endovascular balloon catheter's ability to create a secure tamponade facilitating safe patient transport to an endovascular operating room for permanent repair.
Material and Methods: An embalmed non-injected post-mortem head was used to create the ICA injury model. A transsphenoidal transpterygoid endoscopic approach was performed to expose the pituitary gland and both carotid arteries. Cuts on the carotid artery were performed at different levels of the paraclival and parasellar carotid to simulate different injuries. The common carotid artery was cannulated and the external carotid artery was ligated to avoid blood flow. Using a pulsatile blood pump system (Masterflex) we simulated the ICA injury and used an endovascular balloon catheter (ev3 hyperglide occlusion balloon catheter, 4mm x 15mm) to tamponade the bleeding.
Results: The procedure was successfully performed with safe and fast tamponade of the bleeding (Figure 1).
Conclusion: The live cadaver model, equipped with a pulsatile perfusion system and utilizing lightly embalmed cadaveric specimens, integrates authentic human anatomy with lifelike conditions. It offers a realistic simulation of the scenarios encountered during live surgery, particularly in endoscopic endonasal carotid rupture procedures. To prevent rapid blood loss and stabilize the patient following an injury to the ICA, the use of an endovascular balloon catheter technique can be both effective and expedient. Another advantage of this endovascular balloon technique is that it can be applied through a very small access point, even in cases where the injury occurs before any bone is removed from the specimen.