{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T23:18:29Z","timestamp":1769728709364,"version":"3.49.0"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"12","license":[{"start":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T00:00:00Z","timestamp":1758499200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2025,9,22]]},"abstract":"\n BACKGROUND<\/jats:title>\n Arterial injuries are among the most dangerous complications of endoscopic endonasal skull base surgery (EESBS), posing a risk of massive hemorrhage and requiring immediate management. Although uncommon, such events can be life-threatening. This report describes the first documented case of using a transcranial approach to control an arterial injury sustained during EESBS, with hemostasis achieved via bipolar diathermy.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n During endoscopic resection of a tuberculum sellae meningioma, profuse bleeding from the right frontopolar artery occurred. Initial control measures\u2014large bore suction, hemostatic agents, and muscle packing\u2014proved insufficient through the endonasal route. As an endovascular option was not available, a left pterional craniotomy was performed, where the lacerated artery was successfully coagulated. Simultaneously, endoscopic packing was maintained to limit ongoing hemorrhage. The procedure lasted 10 hours 40 minutes, with a total blood loss of 5 L. The patient survived the event but experienced worsened vision.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n This case underscores the severity of arterial injuries during EESBS and the importance of prompt, adaptable management. Core mitigation strategies include early recognition, precise localization of the bleeding vessel, aggressive packing, and timely conversion to an alternative approach, such as a transcranial route, when endonasal control fails.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25281<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25281","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T00:27:24Z","timestamp":1758587244000},"source":"Crossref","is-referenced-by-count":0,"title":["Transcranial arterial coagulation with cardiac standstill after catastrophic frontopolar artery injury during endoscopic endonasal resection of tuberculum sellae meningioma: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8915-4131","authenticated-orcid":true,"given":"Edmund John B.","family":"Cayanong","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel I.","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2857-2601","authenticated-orcid":true,"given":"Angelo Augusto M.","family":"Sumalde","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenny S.","family":"Seng","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerardo D.","family":"Legaspi","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0451-9489","authenticated-orcid":true,"given":"Arsenio Claro A.","family":"Cabungcal","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4611-3011","authenticated-orcid":true,"given":"Juan Silvestre G.","family":"Pascual","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"12","key":"bib1","series-title":"Brain Sci","first-page":"1685","article-title":"Endoscopic endonasal skull base surgery complication avoidance: a contemporary review","volume":"12","author":"Porras","year":"2022","unstructured":"Porras JLRowan NRMukherjee D.Endoscopic endonasal skull base surgery complication avoidance: a contemporary review. Brain Sci. 2022;12(12):1685."},{"issue":"3","key":"bib2","series-title":"Otolaryngol Clin North Am","first-page":"819","article-title":"Management of major vascular injury during endoscopic endonasal skull base surgery","volume":"49","author":"Gardner","year":"2016","unstructured":"Gardner PASnyderman CHFernandez-Miranda JCJankowitz BT.Management of major vascular injury during endoscopic endonasal skull base surgery. Otolaryngol Clin North Am. 2016;49(3):819-828."},{"issue":"5","key":"bib3","series-title":"Otolaryngol Clin North Am","first-page":"1059","article-title":"Carotid artery injury after endonasal surgery","volume":"44","author":"Valentine","year":"2011","unstructured":"Valentine RWormald PJ.Carotid artery injury after endonasal surgery. Otolaryngol Clin North Am. 2011;44(5):1059-1079."},{"issue":"8","key":"bib4","series-title":"Cureus","first-page":"e5537","article-title":"Management of noncatastrophic internal carotid artery injury in endoscopic skull base surgery","volume":"11","author":"Safaee","year":"2019","unstructured":"Safaee MYoung JSEl-Sayed IHTheodosopoulos PV.Management of noncatastrophic internal carotid artery injury in endoscopic skull base surgery. Cureus. 2019;11(8):e5537."},{"issue":"2","key":"bib5","series-title":"Acta Otorhinolaryngol Ital","first-page":"130","article-title":"Internal carotid artery injury during endonasal sinus surgery: our experience and review of the literature","volume":"39","author":"Lum","year":"2019","unstructured":"Lum SGGendeh BSHusain SInternal carotid artery injury during endonasal sinus surgery: our experience and review of the literature. Acta Otorhinolaryngol Ital. 2019;39(2):130-136."},{"issue":"1","key":"bib6","series-title":"Oper Neurosurg","first-page":"138","article-title":"Managing arterial injury in endoscopic skull base surgery: case series and review of the literature","volume":"13","author":"Romero","year":"2017","unstructured":"Romero ADCBlal Gangadharan JBander EDGobin YPAnand VKSchwartz TH.Managing arterial injury in endoscopic skull base surgery: case series and review of the literature. Oper Neurosurg. 2017;13(1):138-149."},{"issue":"5","key":"bib7","series-title":"J Neurosurg","first-page":"1256","article-title":"Endovascular management of internal carotid artery injuries secondary to endonasal surgery: case series and review of the literature","volume":"125","author":"Sylvester","year":"2016","unstructured":"Sylvester PTMoran CJDerdeyn CPEndovascular management of internal carotid artery injuries secondary to endonasal surgery: case series and review of the literature. J Neurosurg. 2016;125(5):1256-1276."},{"issue":"1","key":"bib8","series-title":"J Neurointerv Surg","first-page":"67","article-title":"Emergency reconstructive endovascular management of intraoperative complications involving the internal carotid artery from trans-sphenoidal surgery","volume":"7","author":"Griauzde","year":"2015","unstructured":"Griauzde JGemmete JJPandey ASMcKean ELSullivan SEChaudhary N.Emergency reconstructive endovascular management of intraoperative complications involving the internal carotid artery from trans-sphenoidal surgery. J Neurointerv Surg. 2015;7(1):67-71."},{"issue":"6","key":"bib9","series-title":"J Neurosurg","first-page":"1544","article-title":"Endoscopic endonasal skull base surgery: analysis of complications in the authors\u2019 initial 800 patients","volume":"114","author":"Kassam","year":"2011","unstructured":"Kassam ABPrevedello DMCarrau RLEndoscopic endonasal skull base surgery: analysis of complications in the authors\u2019 initial 800 patients. J Neurosurg. 2011;114(6):1544-1568."},{"key":"bib10","series-title":"World Neurosurg","first-page":"537","article-title":"Anterior cerebral artery rupture during extended endoscopic endonasal transsphenoidal approach for severely calcified craniopharyngioma","volume":"126","author":"Wang","year":"2019","unstructured":"Wang CZhang YWang JNi S.Anterior cerebral artery rupture during extended endoscopic endonasal transsphenoidal approach for severely calcified craniopharyngioma. World Neurosurg. 2019;126:537-540."},{"issue":"2","key":"bib11","series-title":"Neurosurg Focus Video","first-page":"V3","article-title":"Endoscopic endonasal resection of a large tuberculum sella meningioma","volume":"2","author":"Mohyeldin","year":"2020","unstructured":"Mohyeldin ANayak JVFernandez-Miranda JC.Endoscopic endonasal resection of a large tuberculum sella meningioma. Neurosurg Focus Video. 2020;2(2):V3."},{"issue":"6","key":"bib12","series-title":"J Clin Neurosci","first-page":"786","article-title":"Surgical complications after endoscopic transsphenoidal pituitary surgery","volume":"16","author":"Charalampaki","year":"2009","unstructured":"Charalampaki PAyyad AKockro RAPerneczky A.Surgical complications after endoscopic transsphenoidal pituitary surgery. J Clin Neurosci. 2009;16(6):786-789."},{"issue":"1","key":"bib13","series-title":"Brain Sci","first-page":"99","article-title":"Internal carotid artery injury in transsphenoidal surgery: tenets for its avoidance and refit\u2014a clinical study","volume":"11","author":"Usachev","year":"2021","unstructured":"Usachev DSharipov OAbdali AInternal carotid artery injury in transsphenoidal surgery: tenets for its avoidance and refit\u2014a clinical study. Brain Sci. 2021;11(1):99."},{"issue":"3","key":"bib14","series-title":"J Neurol Surg Rep","first-page":"e52","article-title":"Intracranial intradural vascular injury during endoscopic endonasal transsphenoidal surgery: a case report and literature review","volume":"81","author":"Babgi","year":"2020","unstructured":"Babgi MAlsaleh SBabgi YBaeesa SAjlan A.Intracranial intradural vascular injury during endoscopic endonasal transsphenoidal surgery: a case report and literature review. J Neurol Surg Rep. 2020;81(3):e52-e58."},{"issue":"12","key":"bib1","series-title":"Brain Sci","first-page":"1685","article-title":"Endoscopic endonasal skull base surgery complication avoidance: a contemporary review","volume":"12","author":"Porras","year":"2022","unstructured":"Porras JLRowan NRMukherjee D.Endoscopic endonasal skull base surgery complication avoidance: a contemporary review. Brain Sci. 2022;12(12):1685."},{"issue":"3","key":"bib2","series-title":"Otolaryngol Clin North Am","first-page":"819","article-title":"Management of major vascular injury during endoscopic endonasal skull base surgery","volume":"49","author":"Gardner","year":"2016","unstructured":"Gardner PASnyderman CHFernandez-Miranda JCJankowitz BT.Management of major vascular injury during endoscopic endonasal skull base surgery. Otolaryngol Clin North Am. 2016;49(3):819-828."},{"issue":"5","key":"bib3","series-title":"Otolaryngol Clin North Am","first-page":"1059","article-title":"Carotid artery injury after endonasal surgery","volume":"44","author":"Valentine","year":"2011","unstructured":"Valentine RWormald PJ.Carotid artery injury after endonasal surgery. Otolaryngol Clin North Am. 2011;44(5):1059-1079."},{"issue":"8","key":"bib4","series-title":"Cureus","first-page":"e5537","article-title":"Management of noncatastrophic internal carotid artery injury in endoscopic skull base surgery","volume":"11","author":"Safaee","year":"2019","unstructured":"Safaee MYoung JSEl-Sayed IHTheodosopoulos PV.Management of noncatastrophic internal carotid artery injury in endoscopic skull base surgery. Cureus. 2019;11(8):e5537."},{"issue":"2","key":"bib5","series-title":"Acta Otorhinolaryngol Ital","first-page":"130","article-title":"Internal carotid artery injury during endonasal sinus surgery: our experience and review of the literature","volume":"39","author":"Lum","year":"2019","unstructured":"Lum SGGendeh BSHusain SInternal carotid artery injury during endonasal sinus surgery: our experience and review of the literature. Acta Otorhinolaryngol Ital. 2019;39(2):130-136."},{"issue":"1","key":"bib6","series-title":"Oper Neurosurg","first-page":"138","article-title":"Managing arterial injury in endoscopic skull base surgery: case series and review of the literature","volume":"13","author":"Romero","year":"2017","unstructured":"Romero ADCBlal Gangadharan JBander EDGobin YPAnand VKSchwartz TH.Managing arterial injury in endoscopic skull base surgery: case series and review of the literature. Oper Neurosurg. 2017;13(1):138-149."},{"issue":"5","key":"bib7","series-title":"J Neurosurg","first-page":"1256","article-title":"Endovascular management of internal carotid artery injuries secondary to endonasal surgery: case series and review of the literature","volume":"125","author":"Sylvester","year":"2016","unstructured":"Sylvester PTMoran CJDerdeyn CPEndovascular management of internal carotid artery injuries secondary to endonasal surgery: case series and review of the literature. J Neurosurg. 2016;125(5):1256-1276."},{"issue":"1","key":"bib8","series-title":"J Neurointerv Surg","first-page":"67","article-title":"Emergency reconstructive endovascular management of intraoperative complications involving the internal carotid artery from trans-sphenoidal surgery","volume":"7","author":"Griauzde","year":"2015","unstructured":"Griauzde JGemmete JJPandey ASMcKean ELSullivan SEChaudhary N.Emergency reconstructive endovascular management of intraoperative complications involving the internal carotid artery from trans-sphenoidal surgery. J Neurointerv Surg. 2015;7(1):67-71."},{"issue":"6","key":"bib9","series-title":"J Neurosurg","first-page":"1544","article-title":"Endoscopic endonasal skull base surgery: analysis of complications in the authors\u2019 initial 800 patients","volume":"114","author":"Kassam","year":"2011","unstructured":"Kassam ABPrevedello DMCarrau RLEndoscopic endonasal skull base surgery: analysis of complications in the authors\u2019 initial 800 patients. J Neurosurg. 2011;114(6):1544-1568."},{"key":"bib10","series-title":"World Neurosurg","first-page":"537","article-title":"Anterior cerebral artery rupture during extended endoscopic endonasal transsphenoidal approach for severely calcified craniopharyngioma","volume":"126","author":"Wang","year":"2019","unstructured":"Wang CZhang YWang JNi S.Anterior cerebral artery rupture during extended endoscopic endonasal transsphenoidal approach for severely calcified craniopharyngioma. World Neurosurg. 2019;126:537-540."},{"issue":"2","key":"bib11","series-title":"Neurosurg Focus Video","first-page":"V3","article-title":"Endoscopic endonasal resection of a large tuberculum sella meningioma","volume":"2","author":"Mohyeldin","year":"2020","unstructured":"Mohyeldin ANayak JVFernandez-Miranda JC.Endoscopic endonasal resection of a large tuberculum sella meningioma. Neurosurg Focus Video. 2020;2(2):V3."},{"issue":"6","key":"bib12","series-title":"J Clin Neurosci","first-page":"786","article-title":"Surgical complications after endoscopic transsphenoidal pituitary surgery","volume":"16","author":"Charalampaki","year":"2009","unstructured":"Charalampaki PAyyad AKockro RAPerneczky A.Surgical complications after endoscopic transsphenoidal pituitary surgery. J Clin Neurosci. 2009;16(6):786-789."},{"issue":"1","key":"bib13","series-title":"Brain Sci","first-page":"99","article-title":"Internal carotid artery injury in transsphenoidal surgery: tenets for its avoidance and refit\u2014a clinical study","volume":"11","author":"Usachev","year":"2021","unstructured":"Usachev DSharipov OAbdali AInternal carotid artery injury in transsphenoidal surgery: tenets for its avoidance and refit\u2014a clinical study. Brain Sci. 2021;11(1):99."},{"issue":"3","key":"bib14","series-title":"J Neurol Surg Rep","first-page":"e52","article-title":"Intracranial intradural vascular injury during endoscopic endonasal transsphenoidal surgery: a case report and literature review","volume":"81","author":"Babgi","year":"2020","unstructured":"Babgi MAlsaleh SBabgi YBaeesa SAjlan A.Intracranial intradural vascular injury during endoscopic endonasal transsphenoidal surgery: a case report and literature review. J Neurol Surg Rep. 2020;81(3):e52-e58."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/10\/12\/article-CASE25281.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/10\/12\/article-CASE25281.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/10\/12\/article-CASE25281.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T11:14:01Z","timestamp":1769685241000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/10\/12\/article-CASE25281.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,22]]},"references-count":28,"journal-issue":{"issue":"12"},"URL":"https:\/\/doi.org\/10.3171\/case25281","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,22]]}}}