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Journal of Korean Neurosurgical Society > Epub ahead of print

doi: https://doi.org/10.3340/jkns.2024.0143    [Epub ahead of print]
A Successful Control of the Intraoperative Bleeding from McConnell’s Artery during Fully Endoscopic Resection of Planum Sphenoidale Meningioma Using Bone Chip and Bioglue : A Case Report
Guenther C Feigl1,2,3 , Roman Bosnjak1,4 , Daniel Staribacher1 , Gavin Britz3 , Dzmitry Kuzmin1
1Department of Neurosurgery, General Hospital Bamberg, Bamberg, Germany
2Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany
3Department of Neurological Surgery, Houston Methodist Hospital, Houston, TX, USA
4Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
Correspondence  Guenther C Feigl ,Tel: +49 951 503 15659, Fax: +49 951 503 12181, Email: guenther.feigl@web.de
Received: July 26, 2024; Revised: October 1, 2024   Accepted: October 2, 2024.  Published online: January 17, 2025.
ABSTRACT
The endoscopic transsphenoidal approach is a common approach used in skull base neurosurgery to reach the sellar region. One of the intraoperative risks of this approach is intraoperative bleeding out of the carotid artery. Gentle drilling can prevent carotid artery injury. However, injury to smaller branches, such as the McConnell’s capsular artery, which is located within the surgical corridor, is more difficult to prevent. If such an injury is within the junction to the main trunk of the carotid artery, there will be a small circular defect in this area. This can result in massive blood loss and should be closed surgically immediately. We describe a clinical case of intraoperative bleeding from the McConnell’s artery originating from the carotid arterial segment (C4) in a 78-year-old female patient operated on for planum sphenoidale meningioma via endoscopic transsphenoidal approach, as well as provide a technical note on a possible technique for bleeding control in such cases. Pinpoint carotid bleeding as a result of intraoperative injury can be stopped by wedging a bone fragment in the carotid canal and fixing it in that position with histoacryl glue at the defect site.
Key Words: Carotid artery · McConnell's artery · Bleeding · Endoscopic · Transsphenoidal approach
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