J Korean Neurosurg Soc.  2025 Mar;68(2):223-228. 10.3340/jkns.2024.0143.

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

• Feigl GC
• Bosnjak R
• Staribacher D
• Britz G
• Kuzmin D

• KMID: 2565279
• DOI: http://doi.org/10.3340/jkns.2024.0143

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.

Keyword

Carotid artery; McConnell's artery; Bleeding; Endoscopic; Transsphenoidal approach

Figure

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  Fig. 1. McConnell’s artery is marked with red arrow (A and B). Reused from Rhoton [13].

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  Fig. 2. The preoperative contrast-enhanced T1-weighted MRI scans in the axial (A), sagittal (B), and coronal (C) plans show planum sphenoidale meningioma with left optic nerve compression.

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  Fig. 3. The intraoperative photos show bleeding from the McConnell’s capsular artery (A) and a fixed bone fragment at the defect site (B and C).

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  Fig. 4. The postoperative computed tomography (CT) and magnetic resonance imaging (MRI) scans. A : The CT angiography scans immediately after the surgery did not show pseudoaneurysms or active carotid bleeding (inserted bone chip is marked with red arrow). The postoperative contrast-enhanced T1-weighted MRI scans in the axial (B), sagittal (C), and coronal (D) plans made 3 months after the surgery show no tumor recurrence.

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  Fig. 5. Schematic illustration of closing the defect in the carotid arterial wall by wedging a bone fragment in the carotid canal between the carotid artery and the surrounding bone. Courtesy of Palina Andreyeva. ACA : anterior cerebral artery.

Reference

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