[High exposure of the distal internal carotid artery]

High exposure of the internal carotid artery is a challenging procedure even for experienced surgeons. Access to the distal internal carotid artery is impeded by progressive encroachment of the mastoid process and the angle of the mandible and furthermore at this level the artery is intimately associated with the hypoglossal and glossopharyngeal nerves. If high exposure is needed we prefer preparation of the distal internal carotid artery by dissection of the venter posterior of the digastric muscle and the styloid process including the stylohyoid and stylopharyngeus muscles. This procedure can be advantageously carried out without additional preoperative requirements. The need for high access to the internal carotid artery depends strongly on the underlying pathology: in atherosclerotic disease the rate of high access in our patients is approximately 4.4%, whereas in carotid aneurysms the rate is considerably higher and averages about 15%.