Endo Arumu, Toyooka Terushige, Fujii Kazuya, Takeuchi Satoru, Yoshiura Toru, Nakagawa Masaya, Otsuka Yohei, Tomiyama Arata, Wada Kojiro
Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
Asian J Neurosurg. 2024 Oct 18;20(1):149-154. doi: 10.1055/s-0044-1791841. eCollection 2025 Mar.
The knowledge of both normal and abnormal anatomy of the veins of the neck may be important for surgeons performing carotid endarterectomy (CEA), to avoid inadvertent injury to vascular structures. We present three cases of abnormal course of the internal jugular vein (IJV) which run anterior to the common carotid artery, named twisted IJV, that usually run posterolateral to the common carotid artery in patients undergoing CEA. These twisted IJV cases were detected by preoperative multidetector computed tomography angiography evaluation. During the CEA procedure, before identifying the common carotid artery, we dissected the retromandibular space to find the common facial vein. Then, dissection proceeded along the common facial vein caudally to find the IJV. After ligation and cutting of the common facial vein, a carotid sheath with the IJV turned laterally revealed the common carotid artery safely, and CEA was accomplished. Our clinical experience shows that knowledge of the anatomical anomaly of the IJV allows safe dissection of the carotid triangle avoiding inadvertent injury to the vasculature and vagus nerve.
了解颈部静脉的正常和异常解剖结构对于进行颈动脉内膜切除术（CEA）的外科医生来说可能很重要，以避免意外损伤血管结构。我们报告了3例颈内静脉（IJV）走行异常的病例，这些颈内静脉走行于颈总动脉前方，称为扭曲颈内静脉，而在接受CEA的患者中，颈内静脉通常走行于颈总动脉的后外侧。这些扭曲颈内静脉病例是通过术前多排计算机断层扫描血管造影评估发现的。在CEA手术过程中，在识别颈总动脉之前，我们解剖下颌后间隙以找到面总静脉。然后，沿着面总静脉向尾侧进行解剖以找到颈内静脉。在结扎并切断面总静脉后，颈内静脉向外侧翻转的颈动脉鞘安全地显露了颈总动脉，从而完成了CEA手术。我们的临床经验表明，了解颈内静脉的解剖异常情况可使颈动脉三角的解剖操作安全进行，避免意外损伤血管和迷走神经。
