SM13: Endoscopic Techniques Evolve As New Treatment for Sinonasal Malignancies

Preventing intra-operative nerve injury involves active nerve monitoring, image guidance, nerve stimulator dissection, selectiveness about using bipolar cautery, and the use of irrigation. He added that it’s important to counsel patients about the nerve injury risks, especially since damage usually won’t be apparent until the patient wakes up from the surgery.

Arterial injury is rare, and the keys to its prevention are having an experienced team and sometimes getting an open control of the neck vessels before the procedure. But, once an injury happens, managing it right away is crucial, by keeping arterial pressures high for brain perfusion, getting quick blood transfusions and working in spurts to let blood transfusions keep pace, Dr. Zanation said.

He said that in a review of cases from his institution, only four of 334 patients had intra-operative arterial bleeds, and none had permanent neurological deficits. He added that the long-term stroke risk is unknown, however.

These procedures can be tiring, he said, and it’s important to ask for help when it’s needed. “That’s probably my biggest pearl,” he said. “You’re going to do these long cases. [If] you get a problem at the end of a long case, don’t be afraid to call your partners and say, ‘Hey, I just need a fresh set of hands and a fresh set of eyes.’”