Cervical-to-petrous internal carotid artery bypass procedure

Technical note

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✓ The technique for cervical-to-petrous internal carotid artery saphenous vein bypass is described. This procedure was used in the treatment of three patients with high cervical or skull base vascular injuries. All grafts were patent on follow-up angiography.

Article Information

Address for Dr. Ballard: Department of Surgery, Maricopa Medical Center, Phoenix, Arizona.Address for Dr. Zimmerman: Department of Neurosurgery, Mayo Clinic, Scottsdale, Scottsdale, Arizona.Address reprint requests to: Robert F. Spetzler, M.D., c/o Editorial Department, Barrow Neurological Institute, 350 West Thomas Road, Phoenix, Arizona 85013.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Illustrations of the procedure. Left: The floor of the temporal fossa is drilled to expose the horizontal segment of the petrous internal carotid artery (ICA). The greater petrosal nerve may be divided to avoid traction on the facial nerve. Center: The petrous ICA is divided after the ICA is permanently occluded proximally and temporarily occluded distally. Right: The vein graft is anastomosed end-to-end with the distal segment of the petrous ICA.

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    Schematic illustration of the cervical-to-petrous internal carotid artery bypass.

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    Left: Left internal carotid artery angiogram showing an aneurysm in the high cervical carotid artery extending into the skull base. This patient presented with persistent transient ischemic attacks despite maximum medical therapy. There was no history of trauma. Right: Postoperative anteroposterior common carotid artery injection angiogram showing the patent graft.

References

  • 1.

    Batzdorf UGregorius FK: Surgical exposure of the high cervical carotid artery: experimental study and review. Neurosurgery 13:6576611983Batzdorf U Gregorius FK: Surgical exposure of the high cervical carotid artery: experimental study and review. Neurosurgery 13:657–661 1983

    • Search Google Scholar
    • Export Citation
  • 2.

    Biller JHingtgen WLAdams HP Jret al: Cervicocephalic arterial dissections. A ten-year experience. Arch Neurol 43:123412381986Biller J Hingtgen WL Adams HP Jr et al: Cervicocephalic arterial dissections. A ten-year experience. Arch Neurol 43:1234–1238 1986

    • Search Google Scholar
    • Export Citation
  • 3.

    Fisch UPOldring DJSenning A: Surgical therapy of internal carotid artery lesions of the skull base and temporal bone. Otolaryngol Head Neck Surg 88:5485541980Fisch UP Oldring DJ Senning A: Surgical therapy of internal carotid artery lesions of the skull base and temporal bone. Otolaryngol Head Neck Surg 88:548–554 1980

    • Search Google Scholar
    • Export Citation
  • 4.

    Fisher DF JrClagett GPParker JIet al: Mandibular subluxation for high carotid exposure. J Vase Surg 1:7277331984Fisher DF Jr Clagett GP Parker JI et al: Mandibular subluxation for high carotid exposure. J Vase Surg 1:727–733 1984

    • Search Google Scholar
    • Export Citation
  • 5.

    Friedman WADay ALQuisling RGet al: Cervical carotid dissecting aneurysms. Neurosurgery 7:2072141980Friedman WA Day AL Quisling RG et al: Cervical carotid dissecting aneurysms. Neurosurgery 7:207–214 1980

    • Search Google Scholar
    • Export Citation
  • 6.

    Glasscock ME: Exposure of the intra-petrous portion of the carotid artery in Hamberger CAWersäll J (eds): Disorders of the Skull Base Region: Proceedings of the Tenth Nobel Symposium Stockholm 1968. Stockholm: Almqvist & Wiksell1969 pp 135143Glasscock ME: Exposure of the intra-petrous portion of the carotid artery in Hamberger CA Wersäll J (eds): Disorders of the Skull Base Region: Proceedings of the Tenth Nobel Symposium Stockholm 1968. Stockholm: Almqvist & Wiksell 1969 pp 135–143

    • Search Google Scholar
    • Export Citation
  • 7.

    Lougheed WMMarshall BMHunter Met al: Common carotid to intracranial internal carotid bypass venous graft. Technical note. J Neurosurg 34:1141181971Lougheed WM Marshall BM Hunter M et al: Common carotid to intracranial internal carotid bypass venous graft. Technical note. J Neurosurg 34:114–118 1971

    • Search Google Scholar
    • Export Citation
  • 8.

    Miyazaki SFukushima TFujimaki T: Resection of high-cervical paraganglioma with cervical-to-petrous internal carotid artery saphenous vein bypass. Report of two cases. J Neurosurg 73:1411461990Miyazaki S Fukushima T Fujimaki T: Resection of high-cervical paraganglioma with cervical-to-petrous internal carotid artery saphenous vein bypass. Report of two cases. J Neurosurg 73:141–146 1990

    • Search Google Scholar
    • Export Citation
  • 9.

    Mokri BPiepgras DGHouser OW: Traumatic dissections of the extracranial internal carotid artery. J Neurosurg 68:1891971988Mokri B Piepgras DG Houser OW: Traumatic dissections of the extracranial internal carotid artery. J Neurosurg 68:189–197 1988

    • Search Google Scholar
    • Export Citation
  • 10.

    Paullus WSPait TGRhoton AL Jr: Microsurgical exposure of the petrous portion of the carotid artery. J Neurosurg 47:7137261977Paullus WS Pait TG Rhoton AL Jr: Microsurgical exposure of the petrous portion of the carotid artery. J Neurosurg 47:713–726 1977

    • Search Google Scholar
    • Export Citation
  • 11.

    Sandmann WHennerici MAulich Aet al: Progress in carotid artery surgery at the base of the skull. J Vase Surg 1:7347431984Sandmann W Hennerici M Aulich A et al: Progress in carotid artery surgery at the base of the skull. J Vase Surg 1:734–743 1984

    • Search Google Scholar
    • Export Citation
  • 12.

    Sekhar LNSchramm VL JrJones NF: Subtemporal- and posterior cranial base neoplasms. J Neurosurg 67:4884991987Sekhar LN Schramm VL Jr Jones NF: Subtemporal- and posterior cranial base neoplasms. J Neurosurg 67:488–499 1987

    • Search Google Scholar
    • Export Citation
  • 13.

    Sekhar LNSchramm VL JrJones NFet al: Operative exposure and management of the petrous and upper cervical internal carotid artery. Neurosurgery 19:9679821986Sekhar LN Schramm VL Jr Jones NF et al: Operative exposure and management of the petrous and upper cervical internal carotid artery. Neurosurgery 19:967–982 1986

    • Search Google Scholar
    • Export Citation
  • 14.

    Shaha APhillips TScalea Tet al: Exposure of the internal carotid artery near the skull base: the posterolateral anatomic approach. J Vasc Surg 8:6186221988Shaha A Phillips T Scalea T et al: Exposure of the internal carotid artery near the skull base: the posterolateral anatomic approach. J Vasc Surg 8:618–622 1988

    • Search Google Scholar
    • Export Citation
  • 15.

    Spetzler RFFukushima TMartin Net al: Petrous carotid-to-intradural carotid saphenous vein graft for intracavernous giant aneurysm, tumor, and occlusive cerebrovascular disease. J Neurosurg 73:4965011990Spetzler RF Fukushima T Martin N et al: Petrous carotid-to-intradural carotid saphenous vein graft for intracavernous giant aneurysm tumor and occlusive cerebrovascular disease. J Neurosurg 73:496–501 1990

    • Search Google Scholar
    • Export Citation
  • 16.

    Sundt TM JrPearson BWPeipgras DGet al: Surgical management of aneurysms of the distal extracranial internal carotid artery. J Neurosurg 64:1691821986Sundt TM Jr Pearson BW Peipgras DG et al: Surgical management of aneurysms of the distal extracranial internal carotid artery. J Neurosurg 64:169–182 1986

    • Search Google Scholar
    • Export Citation
  • 17.

    Urken MLBiller HFHaimov M: Intratemporal carotid artery bypass in resection of a base of skull tumor. Laryngoscope 95:147214771985Urken ML Biller HF Haimov M: Intratemporal carotid artery bypass in resection of a base of skull tumor. Laryngoscope 95:1472–1477 1985

    • Search Google Scholar
    • Export Citation

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