The original postoperative period had been unremarkable, but roughly 48 h after surgery, intense clinical deterioration due to hemorrhagic venous infarction of this left cerebellar hemisphere and brain stem developed and necessitated urgent reoperation for the evacuation of hematoma and brain decompression. Thereafter, the individual remained in an extended coma with a severe neurological deficit. After many years of substantial neurorehabilitation, he had been in a position to walk with assistance but had a tracheostomy, required a feeding tube, and voided with a urinary catheter. Such a catastrophic outcome after an apparently insignificant nondominant transverse sinus damage during resection of a tentorial meningioma raises issue whether repair of the sinus wall with conservation of the patency may have avoided this complication inside our patient.Among the many factors that cause intraoperative neurosurgical complications, a significant arterial injury is one of the most damaging. Herein, the authors provide a case of a 76-year-old client who underwent removal of a craniopharyngioma through the pterional approach and experienced serious damage of her sclerotic left inner carotid artery since it was retracted excessively by a brain spatula, which resulted in total sacrifice for the vessel. Despite stable variables on intraoperative monitoring of motor evoked potentials and sufficient collateral the flow of blood, verified by Doppler flowmetry, a large infarct into the left cerebral hemisphere was noted after surgery. Although retraction of movable arteries, veins, and cranial nerves can frequently be done properly during neurosurgical procedures for efficient publicity of this operative field, pushed displacement of a sclerotic internal carotid artery with its paraclinoid part anchored into the fixed distal dural band should truly be prevented because it presents a substantial chance of significant vessel harm. The transpetrosal approach is a complex skull base treatment with a high danger of complications, specially caused by injury regarding the venous system. Its in part pertaining to variability of blood outflow paths and their distinctive habits in each individual patient. To gauge effects and complications after skull base surgery with utilization of the petrosal method alterations, which choice was in line with the detail by detail preoperative evaluation of venous drainage habits. Overall, 74 customers, just who underwent surgery through the transpetrosal method at our institution between 2000 and 2017, had been most notable study. In most cases, the venous drainage design had been examined preoperatively and classified in line with the predominant blood outflow pathway into four types as formerly recommended by Hacker (1) sphenoparietal sinus (SpPrt), (2) sphenobasal vein (SpB), (3) sphenopetrosal sinus (SpPS), and (4) cortical. The bloodstream outflow through the bridging petrosal vein in addition to vein of Labbé has also been taken intoients, 9 had been symptomatic, but all symptoms-aphasia (4 cases), seizures (2 instances), and confusion (3 cases)-fully resolved after traditional treatment. Overall, 13 customers, including 4 symptomatic, had signal changes on T2-weighted mind MRI, that have been optical biopsy permanent just in 3 instances (all asymptomatic). Our suggested surgical method are applied to any type of the venous drainage pattern. Preoperative evaluation and intraoperative preservation for the blood outflow pathways are very important means for safe and effective application regarding the transpetrosal approach.Our recommended surgical strategy can be put on virtually any the venous drainage design. Preoperative analysis and intraoperative conservation for the blood outflow pathways are very important method for secure and efficient application of this transpetrosal approach.Major vascular frameworks are always in danger during complex skull base surgery, particularly with utilization of the endoscopic endonasal approach, and intraoperative harm associated with interior carotid artery (ICA) can be a devastating complication. Herein, we report an instance toxicohypoxic encephalopathy of a young client who’d an important injury for the left ICA during endoscopic resection of a recurrent petrous bone chordoma. Huge bleeding was controlled by a Foley balloon inserted and kept within the resection location. Immediate angiography revealed a persistent drip from the petrous part regarding the remaining ICA, together with vessel had been sacrificed with coiling, since a balloon occlusion test revealed good collateral blood circulation. The individual woke up from anesthesia without a neurological shortage. Salvage resection of recurrent skull base neoplasms deserves specific attention due to the possibility for major vascular damage. In situations of intraoperative ICA damage, its management requires immediate choices, together with available opportunities for endovascular treatment should always be considered.Complications aren’t unusual in the complex field of skull base surgery. The intrinsic relationship of lesions in this area to crucial neurovascular structures, dura mater, and bone tissue may lead to significant morbidity and death. The evolution of endoscopic endonasal surgery has already established a significant effect on this industry as a less invasive Glafenine choice for remedy for chosen lesions, but major morbidity may nonetheless happen; additionally, endoscopic methods happen associated with greater rates of some specific problems, such as for instance cerebrospinal substance leaks.