Abstract
Endoscopic endonasal surgery （EES） has become increasingly popular for the resection of skull base tumors. This approach provides access to the skull base with significant advantages over conventional surgical methods due to better visualization and cosmesis, resulting in shorter hospital admissions and reduced risk of postoperative pain and neurological complications. Although numerous studies have been published detailing complications of EES, few studies describe complications other than cerebrospinal fluid leakage. One of the most devastating complications is massive hemorrhage due to injury to the internal carotid artery （ICA）. The incidence of ICA injury is rare in endoscopic sinus surgery （ESS）, but is more prevalent in EES that involves resection of skull base tumors. During EES, surgeons must have anatomic knowledge of ICA with regard to the operative field and have strategies for dealing with inadvertently inflicted injury to the vessel. There remains significant concern about the ability to manage such injuries when working with an endoscope through a limited operative field. Here we present a patient who suffered from ICA injury during EES for pituitary adenoma, and evaluate strategies for managing ICA injury during EES.
