The direct surgical management of lesions of the high internal carotid artery.

The diagnosis and surgical management of non-penetrating high cervical internal carotid injuries continues to be a major problem. The increased incidence of these lesions is due to the escalation of motor vehicular trauma involving multi-system injuries as seen in our Trauma Unit. Carotid angiographic studies are necessary for diagnosis when there is an index of suspicion at time of injury. There have been varied opinions concerning the best treatment due to the difficulty of direct access to the para-mandibular, para-antantoxial segment of the internal carotid artery. Two cases of post-traumatic aneurysms have been discussed and an innovative surgical technique is demonstrated with excellent results. This technique can be utilized in other lesions of the high carotid artery such as intimal flaw and/or dissection of this vessel. The primary indications for surgical intervention are propagation of emboli originating in the aneurysmal sac and intolerance of head noise to the patients (not seen in our patients).