颈内动脉颅底内镜手术解剖

目的对颅底内镜相关的颈内动脉解剖进行观测,为安全实施手术提供参考。方法对8具成人尸头颈内动脉分别以内镜术式和大体方式解剖,观察颈内动脉和周围结构之间关系,并做相关解剖测量。结果颈内动脉前膝位于蝶窦外侧壁后上和视神经压迹向内下约成60度角方向、鞍底外侧,其水平段和面神经鼓室段大致位于同一直线上,前部和Ⅲ、Ⅳ、Ⅴ等脑神经相邻,后部和耳蜗相邻出破裂孔。结论颈内动脉和耳鼻结构密切相关,其各段都可通过密切关联结构进行定位,了解该区域结构之间关系对安全开展颅底内镜手术意义重大。     

鼻咽癌外科治疗中的颈内动脉保护

颈内动脉出血是晚期鼻咽癌患者较常见、最为严重的并发症，致死致残率极高。颈内动脉出血可发生于术中、术后或者放疗后。预防和处理颈内动脉出血是影响晚期鼻咽癌患者生存期和生活质量的重要课题。总结近年来国内外相关文献，分享预防和处理颈内动脉出血的经验，同时探讨保护颈内动脉同时行鼻咽颅底扩大切除术的治疗方案。     

颈内动脉颅底段重要解剖标志点的影像学测量

目的了解正常成人颈内动脉岩内段各点与咽鼓管圆枕的距离,为鼻内镜颅底相关手术的安全操作提供重要的参考依据。方法选择50例正常成人颅底为研究对象,采用薄层高分辨率CT扫描和图像放大,三维重建,对颈内动脉岩内段距咽鼓管圆枕的距离进行测量,并对测量值进行统计学处理。结果咽鼓管圆枕距离同侧破裂孔距离为（17.440±0.213）mm,距离同侧颈内动脉管外口（27.322±0.271）mm,距离右侧卵圆孔（22.000±0.323）mm。男性咽鼓管圆枕与左侧卵圆孔距离为（21.122±0.314）mm,女性咽鼓管圆枕与左侧卵圆孔距离为（21.228±0.617）mm。结论该研究为鼻内镜颅底手术的安全操作提供了重要的参考依据,对术中暴露和保护岩骨段颈内动脉极为重要,能有效避免术中损伤颈内动脉造成致死性大出血。     

Infiltrating angiolipoma of the nasopharynx: adjacent to an aberrant internal carotid artery

Infiltrating angiolipomas are tumors consisting of adipose tissue marked by vascular proliferation and are nonencapsulated or partially encapsulated. These tumors are very rare in the head and neck. This is the first case report of infiltrating angiolipoma arising from the nasopharynx causing the Eustachian tube dysfunction. A 29-year-old female presented with a history of earfullness and nasal obstruction. A sessile mass was found at the left superior-lateral wall of the nasopharynx. The mass was excised by a transnasal endoscopic approach. The tumor was adhered to the cavernous sinus containing an aberrant internal carotid artery that was located in an abnormally low portion in the cavernous sinus. The patient is currently free of growth of remained tumor 4 years after endoscopic surgery.     

Risk factors for decreased distance between internal carotid artery and pharyngeal wall

Objectives

The risk of disastrous bleeding during pharyngeal surgery is increased in cases of an internal carotid artery (ICA) that is medially displaced due to its anomalous course. We attempted to assess the distance between the ICA and the pharyngeal wall (DIP) and to evaluate the predisposing factors associated with ICA variation.

Methods

The course of ICA was studied in 509 CT scans, and a retrospective chart review was performed. The course of ICA and DIP were evaluated at each level of the pharynx: nasopharynx (NP), oropharynx (OP), and hypopharynx (HP).

Results

The mean DIP value was greatest (15.8 ± 4.6 mm) at NP, decreased at OP (15.8 ± 4.6 mm), and was shortest at HP (13.5 ± 6.0 mm). DIP was significantly shorter in females compared with males at all three pharyngeal levels. Age was inversely correlated with DIP at NP and OP. Tortuous ICA was most common (51.4%), followed by straight (41.2%), kinking (6.9%), and coiling (0.5%) types. DIP was longest in the straight type and decreased as the curvature of ICA increased. The most common ICA type differed between younger (<60 years; 56.2% having the straight type) and older groups (≥60 years; 66.2% having the tortuous type). Females older than 60 years displayed a higher incidence of kinking ICA compared with males.

Conclusions

Hypopharynx, old age, female gender, and tortuous or kinking ICA types were risk factors for a decreased distance between the ICA and the pharyngeal wall. Meticulous examination of the pharyngeal wall should therefore be performed prior to pharyngeal surgery in patients with these associated risk factors.     

Tortuosity of the internal carotid artery — report of three cases and MR-angiography imaging

Three cases of a tortuous internal carotid artery bulging the lateral pharyngeal wall that caused a persistent throat abnormal sensation were presented. Magnetic resonance angiography was non-invasive and useful for establishing its diagnosis. Otolaryngologists should recognize this anomaly, because it may cause a fatal hemorrhage during surgical procedures on the pharynx.     

Tortuous internal carotid artery indenting the piriform sinus: a case report

A case of tortuous internal carotid artery bulging and partially obliterating the piriform sinus, causing a sensation of fullness and abnormal throat, accompanied by choking spells in a 57-year-old patient is presented. Endoscopic examination and computerized tomographic angiography were useful in establishing the diagnosis. This rare anomaly should be recognized in order to prevent possible fatal hemorrhages during further surgical interventions of the piriform sinus.     

Surgical removal of jugular paragangliomas after stenting of the intratemporal internal carotid artery: a preliminary report

OBJECTIVE: Jugular paragangliomas with extensive involvement of the internal carotid artery (ICA) represent a true challenge for surgeons, especially in the presence of inadequate collateral circulation through the circle of Willis. The aim of our study is to present a preliminary report of our experience with the surgical removal of three such cases using the stenting of the ICA as the method of choice for protecting and preserving the integrity of the artery. METHODS: This retrospective study was conducted at Gruppo Otologico, a private referral center for neurotology and skull base surgery. The subjects of our study are three cases of jugular paragangliomas with extensive involvement of the ICA and inadequate collateral circulation. These cases are the first three cases operated at our center after stenting of the intratemporal portion of the ICA. RESULTS: Complete surgical removal of the tumor, including the part involving the ICA, was achieved in all cases. Over a follow-up period of 22 to 30 months, no complications occurred and the patency of the stented arteries was preserved. CONCLUSION: Although more follow-up is still needed before establishing the exact long-term outcome of stenting the intratemporal ICA, our preliminary report shows that the stent has facilitated the complete surgical removal of the tumor, preserving the integrity of the ICA.     

Unilateral spontaneous dissection of the internal carotid artery presenting as hypoglossal nerve palsy

A rare case of an isolated unilateral hypoglossal nerve palsy in a 61-year-old man is reported. Imaging showed a dissection of the extracranial internal carotid artery. The expansion of the circumference of the artery causes compression of the hypoglossal nerve resulting in a palsy. To the best of our knowledge this disorder has twice been dealt with in the otorhinolaryngological literature.     

Isolated vagus nerve paralysis associated with internal carotid artery dissection

Dysphagia and hoarseness caused by laryngopharyngeal paralysis associated with internal carotid artery (ICA) dissection is rare. We reported a case which recovered spontaneously. A 57-year old man visited our hospital complaining of dysphagia and hoarseness lasting for two weeks. Paralysis of right vocal fold and rotational movement of the posterior pharyngeal wall toward the left side during swallowing were observed. Magnetic resonance imaging was performed under diagnosis of isolated right vagus nerve paralysis, and dissection of the right ICA was revealed. He was treated conservatively, and both of laryngopharyngeal movement and the ICA dissection were improved completely. There is a possibility that laryngeal paralysis caused by ICA dissection has been misdiagnosed as an idiopathic paralysis.     

External carotid artery blood supply to the orbit

The utility of angiography and embolisation of selected branches of the external carotid artery is occasionally helpful in the management of recurrent epistaxis, pre-operative devascularisation of tumours such as angiofibromas, and other head and neck conditions. The use of embolisation for recalcitrant post-tonsillectomy bleeding due to the formation of an aneurysm or pseudoaneurysm of branches of the external carotid artery has been described [P. Simoni, J. Bello, B. Kent, Pseudoaneurysm of the lingual artery secondary to tonsillectomy treated with selective embolization, Int. J. Pediatr. Otorhinolaryngol. 59 (2) (2001) 125-128]. There are also reports of pseudoaneurysm formation on the internal carotid following tonsillectomy [F. Tovi, A. Leiberman, Y. Hertzanu, L. Golcman, Pseudoaneurysm of the internal carotid artery secondary to tonsillectomy, Int. J. Pediatr. Otolaryngol. 13 (1987) 69-75]. The repeated presentation of a 5-year-old girl with post-operative tonsillectomy bleeding on three separate occasions, each approximately 1 week apart, prompted the consideration of the diagnosis of aneurysm formation, and hence, angiography was performed. The anomalous finding from this study precluded embolisation due to the risk of blindness. This experience has prompted this review which highlights the important issues of angiographic assessment prior to embolisation. The relevance of this to external carotid artery ligation is also reflected upon.     

Migrating foreign body into the common carotid artery and internal jugular vein – A rare case

Ingested foreign bodies are a fairly common otorhinolaryngological emergencies encountered in Malaysia. The vast majority of these foreign bodies are fish bones which most commonly are impacted at the level of the cricopharynx. Rarely, however, a foreign body may migrate extraluminally and may even extrude subcutaneously. We report a rare occurrence where a fish bone not only migrated extraluminally, it was found to have migrated into the common carotid artery and the internal jugular vein and required surgical removal.     

Diseases of the intrapetrous carotid artery

Summary In the early years of skull base surgery, total tumor removal was often deemed impossible due to involvement of the intrapetrous carotid artery. In contrast, previously considered unresectable lesions may be removed totally in selected cases, with reasonable expectation of successful treatment at the present time. Current techniques and operative exposures, when modified to accommodate the problem of intracranial extensions of tumor and when approached with neurosurgical collaboration, permit the removal of many of these difficult tumors. This retrospective study of 33 patients treated over the past 5 years offers a critical analysis of our treatment, and a categorization of abnormalities known to affect this anatomic region containing the vessel.     

A study of the course of the internal carotid artery in the parapharyngeal space and its clinical importance

The differences in the course and shape of the internal carotid artery (ICA) in the parapharyngeal space were investigated to determine the possible risks for serious hemorrhage during tonsillectomy, drainage of peritonsillar abscess, soft palate injuries, adenoidectomy and velopharyngeoplasty. The course of the ICA was studied in the parapharyngeal spaces of 50 adult cadavers. From each specimen, circumferential sections were obtained and they stained with hematoxylin–eosin and Verhoeff’s elastic staining. The cervical course of the ICA showed no curvature in 70 cases; but in 25 cases it had a medial curve, and five cases showed kinking out of a total 100 dissected carotid sheaths. In two cases, kinking of the ICA was related to the pharyngeal wall. The histological examination of all kinking specimens demonstrated depletion and decreasing muscle tissue in tunica media and an increase was observed in vasa vasorum numbers in the tunica adventitia of ICA. The dissections and integrity losses were seen in tunica media and tunica adventitia. The vessel wall of histological structure change were detected in kinking specimens and lays the groundwork for the vessel wall to get easily harmed or torn either directly or indirectly by decreasing the elasticity and soundness of the wall. The transposition of the ICA artery in submucous position becomes important for otorhinolaryngologists when its aberrant course causes a widening in the retropharyngeal or parapharyngeal tissues and an impression on the pharyngeal wall. Curving and kinking of the ICA can constitue a risk factor for acute hemorrhage in routine surgical procedures, which are performed by inexperienced surgeons.     

外伤性颌内动脉损伤引起严重鼻出血的诊断及治疗探讨(附12例报告)

目的 探讨颌面部外伤引起的颌内动脉损伤致严重鼻出血的发病机制、出血特点、诊断及治疗方法。 方法 回顾分析经手术或数字减影血管造影(DSA)证实颌面外伤引起的颌内动脉损伤致严重鼻出血12例的病例资料。 结果 6例行鼻内镜检查,见鼻腔外侧壁黏膜下有搏动出血,迅速改行柯-陆氏入路找到出血责任血管并止血,其中4例同期行上颌骨、颧骨骨折复位、钛板坚强内固定术。6例行DSA确诊并行血管栓塞治疗。 结论 对颌面外伤后反复鼻腔大出血患者,应考虑颌内动脉损伤,应尽早行鼻内镜检查止血和/或DSA检查并行栓塞治疗。若行鼻内镜检查止血过程中来不及栓塞治疗,可立即经柯-陆氏入路找到出血责任血管行血管结扎或电凝,也可填塞碘仿纱条止血。止血后请口腔颌面外科同期行颌面骨折复位坚强内固定术。     

A case of multiple abnormalities with eustachian tube obstruction by a protruded internal carotid artery

We report a case of multiple abnormalities with eustachian tube obstruction by a protruded internal carotid artery. A 10-year-old male presented with multiple abnormalities including anomalous pinna, poor eyesight, facial palsy, moderate conductive deafness, and otitis media with effusion. Temporal bone computed tomography demonstrated obstruction of the right eustachian tube by a protruded internal carotid artery. Insertion of a tympanostomy tube did not improve his hearing, indicating a possible ossicular chain anomaly. Although tympanoplasty is necessary to improve the patients’ hearing, the poor drainage function makes this difficult. Knowledge of this vascular anomaly is important when performing myringotomy or tympanoplasty.     

Saphenous vein graft for bypass of the external carotid artery to supraclinoid internal carotid artery using a modified technique: An anatomical and technical study

Objective—To investigate the use of a saphenous vein graft for bypass of the external carotid artery (ECA) to supraclinoid internal carotid artery (ICA) when the proximal middle cerebral artery (MCA) is not suitable for a bypass procedure.

Material and Methods—Five adult cadaver sides were used. Dissection required a frontotemporal craniotomy and a zygomatic arch osteotomy, with a hole being opened 2–3 mm lateral to the foramen rotundum extradurally. The ECA was found easily via a second incision in the cervical region. The ophthalmic segment of the ICA was exposed by removal of the anterior clinoid process intradurally. After the dura over the hole was opened, the 7–8-cm long bypass graft was passed just behind the mandibula and through the hole inside the dura to reach the ICA. The ECA was then transected proximal to the occipital artery (OA) branch and the distal side of the vein graft was anastomosed end-to-end with the ECA and end-to-side with the supraclinoid ICA.

Results—The mean diameter of the ECA proximal to the OA was 3.75±0.4 mm (range 3.35–4.15 mm) and that of the supraclinoid ICA was 3.4±0.5 mm (range 2.9–3.9 mm). The mean length of the venous graft was 7.5±0.5 cm (range 7–8 cm).

Conclusion—When high blood flow is needed and the proximal MCA is not suitable for a bypass, the bypass described herein may be an alternative to a superficial temporal to MCA bypass as well as to extracranial carotid artery to MCA or ICA bypasses, which both need long vein grafts.