Abstract
We have experienced a case who suddenly manifested severe hemorrhage during and after open surgery for cysts of posterior paranasal sinuses. In this case, severe hemorrhage was caused by a rupture of aneurysm of the internal carotid artery. The following risk factors for internal carotid artery injuries during surgery have been listed, (1) internal carotid artery runs along sphenoidal sinus, (2) its areas of attachment are broad, (3) the growth of sphenoidal sinus is good, and (4) the sphenoidal sinus walls are thin. In our case who has cysts of posterior paranasal sinuses, there was a risk that the arteries might directly be damaged during surgery because of spatial relationship between the internal carotid artery and sphenoidal sinus, particularly when cysts were destructive to surrounding walls of bones and invasive. Damages to the internal carotid artery could be potentially fatal. In order to avoid possible injuries during surgery, it is important to understand anatomical localization of the posterior paranasal sinuses and internal carotid artery. However, in this type of case, it is important for prevention of complications and injuries to utilize an endoscopy all the time, and to perform operation very carefully with clear visual fields.
