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Intracranial carotid catastrophies encountered by the otolaryngologist
Insights
Traumatic intracranial carotid aneurysms were successfully treated with arterial ligation by a combined surgical team. Patients experienced no significant neurological deficits due to robust collateral circulation.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Intracranial carotid aneurysms, often resulting from trauma, present complex otolaryngologic challenges.
- Arterial ligation is a critical intervention for managing these aneurysms, with indications including neoplasm resection and hemorrhage control.
Observation:
- A combined Otolaryngological and Neurosurgical Team treated three traumatic intracranial carotid aneurysms using various intra and extracranial arterial ligations.
- Arteriographic studies were crucial for visualizing the aneurysms and documenting the outcomes of arterial ligation.
Findings:
- All three aneurysms were successfully controlled without significant neurological impairment in the patients.
- The study highlights the development of intracranial and extracranial collateral circulation following surgical interruption of the common carotid artery, ensuring adequate blood supply to the brain.
Implications:
- Successful carotid ligation, supported by collateral circulation, offers a high survival rate (60%) without neurological sequelae.
- Understanding and demonstrating collateral pathways (e.g., vertebral to external/internal carotid, posterior communicating, ophthalmic artery) is vital for managing cerebrovascular conditions and preventing neurological deficits.
Abstract:
Arteriographic studies are utilized to illustrate the presence and document the results of arterial ligation on three intracranial carotid aneurysms. All three aneurysms resulted from trauma, surgical and otherwise, and all presented as otolaryngologic dilemmas. All were successfully controlled by a combined Otolaryngological and Neurosurgical Team employing varying combinations of intra and extra cranial arterial ligations. None developed significant neurological impairments. The two major indications for common or internal carotid ligation are the resection of neoplasm and the control or prevention of hemorrhage. Sixty percent of patients undergoing elective carotid ligation survive these procedures without evidence of neurological sequelae. This uncompromised survival is based upon the presence or rapid development of collateral circulation to the cerebrovascular bed. Further arteriographic studies are employed to illustrate the development of intra and extra cranial collateralization to the internal carotid artery after surgical interruption of the ipsilateral common carotid. The major collateral circuits demonstrated via a case report are as follows: a. from the vertebral artery to the external carotid and hence to the internal carotid; b. from the posterior communicating artery to the internal carotid; and c. from the ophthalmic artery to the internal carotid.