Blunt injury to the internal carotid artery at the base of the skull: Six cases of venous graft restoration Yves S. Alimi, Pascal Di Mauro, Edouard Fiacre,

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Presentation transcript:

Blunt injury to the internal carotid artery at the base of the skull: Six cases of venous graft restoration Yves S. Alimi, Pascal Di Mauro, Edouard Fiacre, Jacques Magnan, Claude Juhan Journal of Vascular Surgery Volume 24, Issue 2, Pages 249-257 (August 1996) DOI: 10.1016/S0741-5214(96)70100-3 Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 A, Dissection of right ICA and occlusion of left ICA reaching base of skull in 50-year-old woman after motor vehicle accident. B, Postoperative angiogram 10 days after venous graft restoration using a shunt. Journal of Vascular Surgery 1996 24, 249-257DOI: (10.1016/S0741-5214(96)70100-3) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 A, Dissection of right ICA and occlusion of left ICA reaching base of skull in 50-year-old woman after motor vehicle accident. B, Postoperative angiogram 10 days after venous graft restoration using a shunt. Journal of Vascular Surgery 1996 24, 249-257DOI: (10.1016/S0741-5214(96)70100-3) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 A, Carotid angiogram of 21-year-old man reveals false aneurysm of left ICA at base of skull after motor vehicle accident. B, Postoperative angiogram 9 days after operation shows normal venous graft function. Journal of Vascular Surgery 1996 24, 249-257DOI: (10.1016/S0741-5214(96)70100-3) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 A, Carotid angiogram of 21-year-old man reveals false aneurysm of left ICA at base of skull after motor vehicle accident. B, Postoperative angiogram 9 days after operation shows normal venous graft function. Journal of Vascular Surgery 1996 24, 249-257DOI: (10.1016/S0741-5214(96)70100-3) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Skin incision for intrapetrosal ICA approach. Journal of Vascular Surgery 1996 24, 249-257DOI: (10.1016/S0741-5214(96)70100-3) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Surgical exposure of posterior subparotid space and of high cervical ICA. 1, Drilling of mastoid tip; 2, stylomastoid foramen; 3, facial nerve; 4, accessory nerve; 5, internal jugular vein; 6, drilling of tympanal bone; 7, glossopharyngeal nerve; 8, vagus nerve; 9, internal carotid artery; 10, hypoglossal nerve. Journal of Vascular Surgery 1996 24, 249-257DOI: (10.1016/S0741-5214(96)70100-3) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Surgical exposure of vertical intrapetrosal segment of ICA. 1, Rerouting of third portion of facial nerve; 2, jugular bulb; 3, ICA foramen with its fibrous ring; 4, vertical intrapetrosal segment of ICA. Journal of Vascular Surgery 1996 24, 249-257DOI: (10.1016/S0741-5214(96)70100-3) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Surgical exposure of vertical and horizontal intrapetrosal segment of ICA. 1, Rerouting of second and third portion of facial nerve; 2, Stapes in fenestra ovalis; 3, promontory (cochlea); 4, dome of collapsed internal jugular vein; 5, facial nerve protected by parotid tissue; 6, horizontal segment of intrapetrosal ICA; 7, Vertical segment of intrapetrosal ICA. Journal of Vascular Surgery 1996 24, 249-257DOI: (10.1016/S0741-5214(96)70100-3) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Direct visualization of distal ICA by means of an angioscope introduced through small incision of common carotid artery allows determination of exact level of ICA that must be freed. Journal of Vascular Surgery 1996 24, 249-257DOI: (10.1016/S0741-5214(96)70100-3) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions