复杂的颅底手术中，尤其是使用内窥镜经鼻道入路时，主要血管结构总是面临风险，颅内动脉（internal carotid artery，ICA）的术中损伤可能造成严重并发症。本文报道了一例年轻患者，在内窥镜下切除颞骨脑膜瘤复发时，左侧ICA发生了重大损伤。通过插入并保留在切除区域的Foley气囊来控制大出血。紧急进行血管造影显示左侧ICA的颞段仍存在漏血，由于球囊阻塞试验显示有良好的侧支血流，因此舍弃了该血管并进行了线圈栓塞。患者麻醉后没有出现神经功能缺陷。复发颅底肿瘤的挽救性切除应予以特别关注，因为可能导致主要血管损伤。在术中ICA损伤的情况下，其处理需要及时决策，并且应始终考虑内血管治疗的可行性。© 2023. Springer Nature Switzerland AG.

Major vascular structures are always at risk during complex skull base surgery, particularly with use of the endoscopic endonasal approach, and intraoperative damage of the internal carotid artery (ICA) can be a devastating complication. Herein, we report a case of a young patient who had a major injury of the left ICA during endoscopic resection of a recurrent petrous bone chordoma. Massive bleeding was controlled by a Foley balloon inserted and kept in the resection area. Urgent angiography revealed a persistent leak from the petrous segment of the left ICA, and the vessel was sacrificed with coiling, since a balloon occlusion test showed good collateral blood flow. The patient woke up from anesthesia without a neurological deficit. Salvage resection of recurrent skull base neoplasms deserves specific attention because of the possibility of major vascular damage. In cases of intraoperative ICA injury, its management requires immediate decisions, and the available possibilities for endovascular therapy should always be considered.© 2023. Springer Nature Switzerland AG.