Surgical therapy of internal carotid artery lesions of the skull base and temporal bone.

Five cases of carotid artery lesions at the skull base or temporal bone, treated surgically, are presented. These lesions include mycotic aneurysms and carotid stenosis secondary to angiofibroma and a glomus caroticum. One case demonstrated an anomalous carotid anatomic pattern with a persistent stapedial artery. A description is provided of the technique of subtotal petrosectomy with permanent anterior displacement of the facial nerve, and middle ear obliteration, thus achieving a safe exposure of the temporal course of the internal carotid artery. The cases indicate that cooperation between temporal bone surgeons and vascular surgeons is a prerequisite to successful repair of such lesions, as good recovery in all five cases was achieved. The techniques allow maintenance of carotid flow during and after repair, reducing the potential for neurologic complications or mortality.