Catalano P J, Bederson J, Turk J B, Sen C, Biller H F
Department of Otolaryngology, Head and Neck Surgery, Mount Sinai School of Medicine, New York, NY 10029, USA.
Am J Otol. 1994 Jul;15(4):495-501.
Direct operative management of aneurysms of the internal carotid artery is associated with significant morbidity. Preauricular surgical approaches to this area can result in violation of the inner ear, temporomandibular joint, or mandibular ramus, and cranial nerves V, VII, IX, X, XI, and XII. A new technique for saphenous vein bypass of the infratemporal and petrous internal carotid artery, using a postauricular curvelinear groove drilled in the mastoid cortex, is described. Proximally, the reverse vein graft is anastomosed to either the internal or external carotid artery, whereas the distal anastomosis is to the horizontal petrous internal carotid artery. The latter is accessed through a small pterional craniotomy. The internal carotid artery is then ligated between points of anastomosis, thus isolating the lesion and eliminating dissection in the infratemporal fossa. The posterior location of the vein graft also avoids potentially infected areas adjacent to the oropharynx, nasopharynx, and soft tissues of the face. Use of the external carotid artery decreases carotid cross-clamp time and minimizes graft length, and creation of a bony canal protects the graft from subsequent compression and kinking.
颈内动脉动脉瘤的直接手术治疗会带来显著的发病率。该区域的耳前手术入路可能会侵犯内耳、颞下颌关节或下颌支，以及颅神经V、VII、IX、X、XI和XII。本文描述了一种新技术，即利用在乳突皮质钻出的耳后曲线凹槽进行颞下和岩骨段颈内动脉的大隐静脉旁路移植。在近端，将倒置的静脉移植物与颈内动脉或颈外动脉进行吻合，而远端吻合则是与水平段岩骨颈内动脉进行。后者通过一个小的翼点开颅术来显露。然后在吻合点之间结扎颈内动脉，从而隔离病变并避免在颞下窝进行解剖。静脉移植物的后置位置也避免了与口咽、鼻咽和面部软组织相邻的潜在感染区域。使用颈外动脉可减少颈动脉夹闭时间并使移植物长度最小化，并且创建一个骨管可保护移植物免受后续的压迫和扭曲。
