BLUNT INJURY TO THE INTERNAL CAROTID-ARTERY AT THE BASE OF THE SKULL - 6 CASES OF VENOUS GRAFT RESTORATION

Purpose: Blunt injuries to the internal carotid artery (ICA) at the ba se of the skull are uncommon but potentially dangerous lesions whose m anagement remains unclear. We report a new surgical approach of the in trapetrosal portion of the ICA that was used in six patients with the help of an ear, nose, and throat surgeon. Methods: During a 70-month p eriod, seven consecutive patients (four women, three men; mean age, 35 .7 years; range, 21 tc, 59 years) were admitted, six after a motor veh icle accident and one after a cervical manipulation. All patients had a neurologic deficit. An arteriographic scan revealed four unilateral ICA lesions: two false aneurysms, one tight stenosis, and one dissecti on; two cases of bilateral ICA dissection were mentioned, and one case of ICA dissection was associated with a contralateral ICA thrombosis. Results: One patient died before surgery, and six patients underwent a unilateral venous graft restoration, reaching the vertical portion o f the intrapetrosal ICA in two patients and the horizontal portion in four. A shunt was used in one patient. Failure to recognize the end of the ICA lesion was responsible for one postoperative asymptomatic gra ft thrombosis (17%), but this difficulty was overcome by using intraop erative angioscopy in the other patients. No deaths and:no new strokes were noted during postoperative and midterm follow-up (mean follow-up , 34 months). Five postoperative facial pareses occurred and were tota lly regressive within 3 to 6 months in four patients; one total deafne ss was recorded. Conclusion: Venous graft restoration of traumatic ICA lesions at the base of the skull can safely be performed with such an approach, thus producing highly satisfactory results. Before undergoi ng surgery, the patient must be aware of the risk of facial and auditi ve disorders, which are generally temporary.