Emergency treatment and anesthesia management of internal carotid artery injury during neurosurgery: Four case reports

Table 1 The demographic and clinical characteristics of the 4 patients

Case	Age (yr)	Sex	BMI (kg/m2)	Primary disease	Comorbidities	Maximum diameter of tumor (mm)	Tumor recurrence (yes/no)	Operative approach	Location of ICA injury
1	51	Female	25.28	Pituitary adenoma	None	20	Yes	ETTS	C5 segment of right internal carotid artery
2	57	Female	21.50	Pituitary adenoma	Hyperthyroidism, cured	46	No	ETTS	C4 segment of left internal carotid artery
3	32	Male	26.12	Pituitary adenoma	None	30	No	MTTS	C5 segment of right internal carotid artery
4	53	Female	25.63	Right cavernous sinus endothelial meningioma	Allergic asthma	35	No	Right frontotemporal approach	C5 segment of right internal carotid artery

BMI: Body mass index; ETTS: Endoscopic transnasal transsphenoidal approach; MTTS: Microscopically transnasal transsphenoidal approach.

Table 2 Anesthesia management for subsequent surgery and the clinical outcome of the 4 patients

Case	ASA class	Type of anesthesia	Vasoactive drugs	Total infusion (mL)	RBC (mL)	FFP (mL)	Blood loss (mL)	Urine output (mL)	Tumor removal	Endovascular treatment	Prolonged intubation (d)	Length of stay (d)	Outcome	Hospital costs (RMB)
1	IV	TIVA	Adrenaline	6000	520	800	2400	750	Near total	Covered stent	55	62	Died	402167.49
2	III	TIVA	Dopamine	6000	1560	1200	3000	3500	Near total	Covered stent	0	12	Recovered	221113.41
3	III	CIIA	Norepinephrine and adrenaline	4000	260	400	900	800	Near total	Covered stent	1	17	Recovered	209218.11
4	III	CIIA	Norepinephrine and adrenaline	6600	1000	400	2200	4100	Total	Right ICA embolism	1	22	Recovered	165178.78

ASA: American Society of Anesthesiologists; TIVA: Total intravenous anesthesia; CIIA: Combined intravenous and inhaled anesthesia; RBC: Red blood cells; FFP: Fresh frozen plasma; ICA: Internal carotid artery.