Zanaret M, Giovanni A, Cannoni M, Pech A, Piquet P, Branchereau A, Mercier C
Département ORL, CHU Timone, F 13385 Marseille.
Ann Otolaryngol Chir Cervicofac. 1994;111(4):211-6.
The main obstacle to successful management of aneurysms involving the high cervical internal carotid artery (ICA) is to obtain an adequate exposure. In this report we describe our experience in 5 patients presenting carotid aneurysms at the skull base, intermediately below the carotid foramen. Exposure is achieved in two stages. The cervical stage consists in resection of the styloid processes and muscles followed by anterior displacement of the mandibular condyle. This exposes the vertical segment of the petrous ICA. The petrous stage consists in partial petrectomy exposing the jugular bulb and the third segment of the facial nerve. Using this route, the vertical intrapetrous segment of the ICA can be drilled away without damaging the middle ear. In our series, no vascular complications occurred. Damage involving the facial glossopharyngeal and vagal nerves is discussed. This approach appears to be a suitable alternative to the conventional infratemporal approach which sacrifices the middle ear.
成功处理累及高位颈内动脉（ICA）的动脉瘤的主要障碍是获得充分的暴露。在本报告中，我们描述了5例颅底、颈动脉孔稍下方出现颈动脉动脉瘤患者的治疗经验。暴露分两个阶段完成。颈部阶段包括切除茎突和肌肉，随后将下颌髁向前移位。这暴露了岩骨段ICA的垂直部分。岩骨阶段包括部分岩骨切除术，暴露颈静脉球和面神经的第三段。采用此路径，可以磨除ICA岩骨内垂直段而不损伤中耳。在我们的系列病例中，未发生血管并发症。讨论了涉及面、舌咽和迷走神经的损伤情况。这种方法似乎是牺牲中耳的传统颞下方法的合适替代方案。
