Candon E, Marty-Ane C, Pieuchot P, Frerebeau P
Services de Neurochirurgie, CHU Montpellier, France.
Neurosurgery. 1996 Oct;39(4):863-6. doi: 10.1097/00006123-199610000-00047.
We describe a novel cervical-to-petrous internal carotid artery (ICA) saphenous vein in situ bypass for the treatment of a high cervical dissecting aneurysm. The cervical ICA has no major collateral branches and can be used as a tunnel for the vein graft.
A 25-year-old man was involved in a car accident. A cerebral angiogram revealed a right ICA dissection with aneurysm formation at the C1-C2 level. The patient recovered fully and was anticoagulated. Six months after the initial angiogram, a second angiogram disclosed ICA stenosis (80%) and persistence of the traumatic dissecting aneurysm. Definitive surgical bypass was considered the most appropriate course of action.
The horizontal portion of the petrous ICA was exposed by an extradural subtemporal approach. The cervical arteries were exposed by a separate surgical incision. After dividing the petrous ICA and the cervical ICA, the cervical ICA was dilated using a Fogarty balloon embolectomy catheter. A saphenous vein graft was inserted inside the lumen of the cervical ICA and was anastomosed to the ICA end-to-end both proximally and distally (cervical-to-petrous ICA in situ bypass). The graft was patent on the follow-up angiogram.
We describe a new technique that could be considered an alternative to the classical extra-anatomic cervical-to-petrous ICA bypass procedures.
我们描述一种用于治疗高位颈段夹层动脉瘤的新型颈内动脉至岩骨段颈内动脉大隐静脉原位搭桥术。颈段颈内动脉没有主要的侧支分支，可作为静脉移植物的通道。
一名25岁男性遭遇车祸。脑血管造影显示右侧颈内动脉夹层并在C1 - C2水平形成动脉瘤。患者完全康复并接受抗凝治疗。初次血管造影6个月后，第二次血管造影显示颈内动脉狭窄（80%）且创伤性夹层动脉瘤持续存在。确定性手术搭桥被认为是最合适的治疗方案。
通过硬膜外颞下入路暴露岩骨段颈内动脉的水平部分。通过单独的手术切口暴露颈部动脉。在切断岩骨段颈内动脉和颈段颈内动脉后，使用Fogarty球囊取栓导管扩张颈段颈内动脉。将大隐静脉移植物插入颈段颈内动脉管腔内，并在近端和远端与颈内动脉进行端端吻合（颈内动脉至岩骨段颈内动脉原位搭桥）。随访血管造影显示移植物通畅。
我们描述了一种新技术，可被视为经典的非解剖性颈内动脉至岩骨段颈内动脉搭桥手术的替代方法。
