Service de Chirurgie Vasculaire, Faculté de Médecine de Marseille, Hôpital de la Timone, Marseille, France.
J Vasc Surg. 2010 Feb;51(2):323-9. doi: 10.1016/j.jvs.2009.08.084.
Aneurysms of the internal carotid artery (ICA) at the base of the skull are uncommon dangerous lesions whose management remains unclear. The aim of this retrospective study is to report a standardized surgical technique of ICA reconstruction with long-term results.
Between 1988 and 2005, 13 patients (11 men; age 18 to 76 years, mean 42.6 years) underwent lateral skull base approach with cervical-to-petrous carotid artery bypass for repair of ICA aneurysms. Principal elements of the technique were: partial resection of the parotid gland without rerouting of the facial nerve; luxation of mandibula; drilling of the bone.
The 13 patients had unilateral aneurysm of the ICA at the base of the skull. Four aneurysms were of atherosclerotic origin; six fibromuscular dysplasia; two post-traumatic; one cause was undetermined. The mean diameter of the aneurysms was 12 mm (range, 7-21 mm). Twelve patients were symptomatic: six presented neurological events (four strokes, two transient ischemic attack [TIA]); two retinal events; three compressive symptoms (two Horner's syndrome and one paralysis of the glossopharyngeal nerve); one patient presented a visible pulsatile mass in the neck. One patient was asymptomatic. There were no post-operative deaths, one TIA, 13 transient palsies of the lower facial nerve, and one transient palsy of accessory nerve. Palsy of cranial nerves was partial and disappeared within a mean of 5.6 months (range, 1-10 months). The postoperative angiogram showed patency in all but one case (one asymptomatic thrombosis). During follow-up (mean, 152 months), there was one unrelated death, one focal epileptic seizure, and one controlateral TIA. In November 2008, duplex showed patency of all 11 grafts (one death, one thrombosis). At 10 years, the survival, cumulative stroke-free survival, ipsilateral stroke-free, and patency rates was were 90.9%, 100%, 100%, and 92.3%.
Venous graft bypass from the cervical-to-petrous ICA can be performed safely with such an approach and produces durable satisfactory results.
颅底颈内动脉（ICA）动脉瘤是一种罕见的危险病变，其处理方法仍不明确。本回顾性研究的目的是报告一种 ICA 重建的标准化手术技术及其长期结果。
1988 年至 2005 年，13 例患者（11 例男性；年龄 18 至 76 岁，平均 42.6 岁）接受了颅底外侧入路和颈内-岩骨颈动脉旁路术治疗 ICA 动脉瘤。该技术的主要内容包括：部分切除腮腺而不重新吻合面神经；下颌骨脱位；骨钻孔。
13 例患者单侧颅底 ICA 动脉瘤。4 例动脉瘤为动脉粥样硬化性起源；6 例纤维肌性发育不良；2 例创伤后；1 例原因不明。动脉瘤的平均直径为 12mm（范围，7-21mm）。12 例患者有症状：6 例出现神经事件（4 例中风，2 例短暂性脑缺血发作[TIA]）；2 例视网膜事件；3 例压迫症状（2 例霍纳综合征和 1 例舌咽神经麻痹）；1 例患者颈部可见搏动性肿块。1 例患者无症状。术后无死亡，1 例 TIA，13 例面神经暂时性麻痹，1 例副神经暂时性麻痹。颅神经麻痹为部分性，平均 5.6 个月（范围，1-10 个月）内消失。术后血管造影显示除 1 例（无症状性血栓形成）外均通畅。随访期间（平均 152 个月），1 例患者因其他原因死亡，1 例患者出现局灶性癫痫发作，1 例患者出现对侧 TIA。2008 年 11 月，超声检查显示 11 个移植物均通畅（1 例死亡，1 例血栓形成）。10 年时，存活率、无累积中风生存率、同侧无中风生存率和通畅率分别为 90.9%、100%、100%和 92.3%。
通过这种入路进行颈内-岩骨 ICA 静脉旁路移植是安全的，可以产生持久满意的结果。
