Blunt injury to the internal carotid artery at the base of the skull: six cases of venous graft restoration

Abstract

Purpose: Blunt injuries to the internal carotid artery (ICA) at the base of the skull are uncommon but potentially dangerous lesions whose management remains unclear. We report a new surgical approach of the intrapetrosal 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 period, seven consecutive patients (four women, three men; mean age, 35.7 years; range, 21 to 59 years) were admitted, six after a motor vehicle 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 dissection; 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 of 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 graft thrombosis (17%), but this difficulty was overcome by using intraoperative 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 totally regressive within 3 to 6 months in four patients; one total deafness 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 undergoing surgery, the patient must be aware of the risk of facial and auditive disorders, which are generally temporary.