Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.202101931
Jornal Vascular Brasileiro
Review Article

Acesso cirúrgico ao segmento cervical distal da artéria carótida interna e à bifurcação carotídea alta – revisão integrativa da literatura e proposta de protocolo

Surgical access to the distal cervical segment of the internal carotid artery and to a high carotid bifurcation – integrative literature review and protocol proposal

Nicolau Conte Neto; Thais Tapajós Gonçalves; Clarina Louis; Jonas Ikikame; Adenauer Marinho de Oliveira Góes Junior

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Resumo

Resumo: Diversas manobras já foram descritas para o acesso ao segmento distal cervical da artéria carótida interna ou à bifurcação carotídea alta; entretanto, há divergências na sistematização dessas técnicas. O objetivo deste estudo é revisar as técnicas descritas e propor um protocolo prático que auxilie na seleção da técnica mais adequada para cada caso. Para isso, foi realizada uma busca nas bases de dados PubMed Central, Biblioteca Virtual em Saúde e SciELO por artigos sobre o tema, em língua inglesa ou portuguesa, publicados entre os anos de 1980 e 2021. Entre as manobras descritas, parece razoável que as duas etapas iniciais sejam a abordagem ao músculo esternocleidomastóideo, seguida pela secção/retração do ventre posterior do músculo digástrico. Caso necessário, a subluxação mandibular temporária unilateral é um recurso adicional e preferível à divisão do aparato estiloide, devido ao menor potencial de morbidade. Exposições ainda mais amplas podem ser obtidas com as osteotomias mandibulares.

Material Suplementar: Clique aqui.

Palavras-chave

artéria carótida interna, doenças das artérias carótidas, osteotomia mandibular, articulação temporomandibular

Abstract

Several different maneuvers have been described for obtaining access to the distal cervical segment of the internal carotid artery or to a high carotid bifurcation. However there are different approaches to systematization of these techniques. The objective of this study is to review the techniques described and propose a practical protocol to support selection of the most appropriate technique for each case. The review is based on the results of database searches on PubMed Central, the Virtual Health Library (BVSalud), and SciELO for articles on the subject published in English or Portuguese from 1980 to 2021. Among the different maneuvers described, it appears reasonable that the first two steps should be to obtain access at the sternocleidomastoid muscle, followed by section or retraction of the digastric muscle posterior belly. If needed, temporary unilateral mandibular subluxation is an additional resource that is preferable to division of the styloid apparatus process, because of its lesser potential for morbidity. Even wider exposure can be obtained using mandibular osteotomies.

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Keywords

internal carotid artery; carotid artery diseases; mandibular osteotomy; temporomandibular joint.

References

1 Reva VA, Pronchenko AA, Samokhvalov IM. Operative management of penetrating carotid artery injuries. Eur J Vasc Endovasc Surg. 2011;42(1):16-20. http://dx.doi.org/10.1016/j.ejvs.2011.01.025. PMid:21388840.

2 Lee TS, Ducic Y, Gordin E, Stroman D. Management of carotid artery trauma. Craniomaxillofac Trauma Reconstr. 2014;7(3):175-89. http://dx.doi.org/10.1055/s-0034-1372521. PMid:25136406.

3 Fisher DF Jr, Clagett GP, Parker JI, et al. Mandibular subluxation for high carotid exposure. J Vasc Surg. 1984;1(6):727-33. http://dx.doi.org/10.1016/0741-5214(84)90002-8. PMid:6492304.

4 Awasthi D, Smith R. Distal cervical internal carotid artery stenosis. Skull Base Surg. 1994;4(2):110-5. http://dx.doi.org/10.1055/s-2008-1058980. PMid:17170937.

5 Beretta F, Hemida SA, Andaluz N, Zuccarello M, Keller JT. Exposure of the cervical internal carotid artery: surgical steps to the cranial base and morphometric study. Neurosurgery. 2006;59(1, Suppl 1):ONS25-34, discussion ONS25-34. PMid:16888548.

6 Mock CN, Lilly MP, McRae RG, Carney WI Jr. Selection of the approach to the distal internal carotid artery from the second cervical vertebra to the base of the skull. J Vasc Surg. 1991;13(6):846-53. http://dx.doi.org/10.1016/0741-5214(91)90050-5. PMid:2038106.

7 Kiya N, Sawamura Y, Dureza C, Fukushima T. Minimally invasive surgical exposure of the extreme high cervical internal carotid artery: anatomical study. J Clin Neurosci. 2000;7(5):438-44. http://dx.doi.org/10.1054/jocn.1999.0241. PMid:10942667.

8 Devlin M, Hoffmann K, Johnson, W. Comparison of mandibular surgical techniques for accessing cranial base vascular lesions. Skull Base. 2003;13(2):65-72. http://dx.doi.org/10.1055/s-2003-40595.

9 Fortes FSG, da Silva ES, Sennes LU. Mandibular subluxation for distal cervical exposure of the internal carotid artery. Laryngoscope. 2007;117(5):890-3. http://dx.doi.org/10.1097/MLG.0b013e318038161c. PMid:17473690.

10 Izci Y, Moftakhar R, Pyle M, Başkaya MK. Retromandibular fossa approach to the high cervical internal carotid artery: an anatomic study. Neurosurgery. 2008;62(5, Suppl 2):ONS363-9, discussion 369-70. http://dx.doi.org/10.1227/01.neu.0000326020.07187.6b. PMid:18596516.

11 Batzdorf U, Gregorius FK. Surgical exposure of the high cervical carotid artery: experimental study and review. Neurosurgery. 1983;13(6):657-61. http://dx.doi.org/10.1227/00006123-198312000-00007. PMid:6657019.

12 Tanjararak K, Upadhyay S, Thiensri T, et al. Potential surgical exposure of the parapharyngeal internal carotid artery by endonasal, transoral, and transcervical approaches. J Neurol Surg B Skull Base. 2018;79(3):241-9. http://dx.doi.org/10.1055/s-0037-1607289. PMid:29765821.

13 Denli Yalvac ES, Baran O, Aydin AE, Balak N, Tanriover N. Surgical pitfalls in carotid endarterectomy: a new step-by-step approach. J Craniofac Surg. 2018;29(8):2337-43. http://dx.doi.org/10.1097/SCS.0000000000004749. PMid:30052612.

14 Ammirati M, Ma J, Cheatham ML, Mei ZT, Bloch J, Becker DP. The mandibular swing-transcervical approach to the skull base: anatomical study. Technical note. J Neurosurg. 1993;78(4):673-81. http://dx.doi.org/10.3171/jns.1993.78.4.0673. PMid:8450345.

15 Goldsmith MM 3rd, Postma DS, Jones FD. The surgical exposure of penetrating injuries to the carotid artery at the skull base. Otolaryngol Head Neck Surg. 1986;95(3 Pt 1):278-84. http://dx.doi.org/10.1177/01945998860953P103. PMid:3108774.

16 Cantore GP, Delfini R, Mariottini A, Santoro A, Cascone P. Anterior displacement of the mandible for better exposure of the distal segment of the extracranial carotid artery. Acta Neurochir (Wien). 1987;86(1-2):56-60. http://dx.doi.org/10.1007/BF01419505. PMid:3618307.

17 Dossa C, Shepard AD, Wolford DG, Reddy DJ, Ernst CB. Distal internal carotid exposure: a simplified technique for temporary mandibular subluxation. J Vasc Surg. 1990;12(3):319-25. http://dx.doi.org/10.1016/0741-5214(90)90155-4. PMid:2398590.

18 Moreau P, Albat B, Thévenet A. Surgical treatment of extracranial internal carotid artery aneurysm. Ann Vasc Surg. 1994;8(5):409-16. http://dx.doi.org/10.1007/BF02133059. PMid:7811577.

19 Frim DM, Padwa B, Buckley D, Crowell RM, Ogilvy CS. Mandibular subluxation as an adjunct to exposure of the distal internal carotid artery in endarterectomy surgery. Technical note. J Neurosurg. 1995;83(5):926-8. http://dx.doi.org/10.3171/jns.1995.83.5.0926. PMid:7472568.

20 Cartier R, Cartier P, Hudan G, Rousseau M. Combined endarterectomy of the internal carotid artery and persistent hypoglossal artery: an unusual case of carotid revascularization. Can J Surg. 1996;39(2):159-62. PMid:8769929.

21 Simonian GT, Pappas PJ, Padberg FT Jr, et al. Mandibular subluxation for distal internal carotid exposure: technical considerations. J Vasc Surg. 1999;30(6):1116-20. http://dx.doi.org/10.1016/S0741-5214(99)70052-2. PMid:10587398.

22 McCabe JC, St-Hilaire H, Samouhi P, Eisen L. Mandibular subluxation and stabilization for access in distal carotid endarterectomy. J Oral Maxillofac Surg. 2003;61(3):406-8. http://dx.doi.org/10.1053/joms.2003.50068. PMid:12618986.

23 Puggioni A, Delis KT, Fields CE, Viozzi CF, Kallmes DF, Gloviczki P. Large symptomatic carotid body tumor resection aided by preoperative embolization and mandibular subluxation. Perspect Vasc Surg Endovasc Ther. 2005;17(1):21-8. http://dx.doi.org/10.1177/153100350501700106. PMid:15952693.

24 Jaspers GW, Witjes MJ, Van den Dungen JJ, Reintsema H, Zeebregts CJ. Mandibular subluxation for distal internal carotid artery exposure in edentulous patients. J Vasc Surg. 2009;50(6):1519-22. http://dx.doi.org/10.1016/j.jvs.2009.07.068. PMid:19782520.

25 Yoshino M, Fukumoto H, Mizutani T, Yuyama R, Hara T. Mandibular subluxation stabilized by mouthpiece for distal internal carotid artery exposure in carotid endarterectomy. J Vasc Surg. 2010;52(5):1401-4. http://dx.doi.org/10.1016/j.jvs.2010.04.058. PMid:20655685.

26 Capoccia L, Montelione N, Menna D, et al. Mandibular subluxation as an adjunct in very distal carotid arterial reconstruction: Incidence of peripheral and cerebral neurologic sequelae in a single-center experience. Ann Vasc Surg. 2014;28(2):358-65. http://dx.doi.org/10.1016/j.avsg.2013.01.024. PMid:24090828.

27 Dos Santos RB, Queiroz AB, Fidelis RJR, Lopes CF, de Araújo JS. Subluxação da mandíbula para abordagem de bifurcação carotídea alta em paciente com parotidite por contraste iodado: relato de caso e revisão de literatura. J Vasc Bras. 2017;16(4):329-34. http://dx.doi.org/10.1590/1677-5449.001117. PMid:29930669.

28 Iflé IG, van Lammeren GW, van Prooijen WE, de Smet AAEA. Open repair of two ipsilateral extracranial internal carotid artery aneurysms. EJVES Vasc Forum. 2020;48:8-11. http://dx.doi.org/10.1016/j.ejvsvf.2020.06.001.

29 Rhee RY, Gloviczki P, Cherry KJ Jr, Edwards WD. Two unusual variants of internal carotid artery aneurysms due to fibromuscular dysplasia. Ann Vasc Surg. 1996;10(5):481-5. http://dx.doi.org/10.1007/BF02000597. PMid:8905069.

30 Shaha A, Phillips T, Scalea T, et al. Exposure of the internal carotid artery near the skull base: the posterolateral anatomic approach. J Vasc Surg. 1988;8(5):618-22. http://dx.doi.org/10.1016/0741-5214(88)90314-X. PMid:3184316.

31 Sasaki T, Nakamura Y, Yomo S, et al. The posterior cervical triangle approach for high carotid artery exposure in carotid endarterectomy. J Neurosurg. 2012;116(3):680-4. http://dx.doi.org/10.3171/2011.11.JNS11563. PMid:22196095.

32 Hans SS, Shah S, Hans B. Carotid endarterectomy for high plaques. Am J Surg. 1989;157(4):431-4, discussion 434-5. http://dx.doi.org/10.1016/0002-9610(89)90593-X. PMid:2929868.

33 Malikov S, Thomassin JM, Magnan PE, Keshelava G, Bartoli M, Branchereau A. Open surgical reconstruction of the internal carotid artery aneurysm at the base of the skull. J Vasc Surg. 2010;51(2):323-9. http://dx.doi.org/10.1016/j.jvs.2009.08.084. PMid:20141956.

34 Smith GI, Brennan PA, Webb AA, Ilankovan V. Vertical ramus osteotomy combined with a parasymphyseal mandibulotomy for improved access to the parapharyngeal space. Head Neck. 2003;25(12):1000-3. http://dx.doi.org/10.1002/hed.10321. PMid:14648858.

35 Dichtel WJ, Washington, Miller RH, Feliciano D, Woodson G, Hurt J. Lateral mandibulotomy: a technique of exposure for penetrating injuries of the internal carotid artery at the base of the skull. Laryngoscope. 1984;94(9):1140-4. http://dx.doi.org/10.1288/00005537-198409000-00002. PMid:6472009.

36 Larsen PE, Smead WL. Vertical ramus osteotomy for improved exposure of the distal internal carotid artery: A new technique. J Vasc Surg. 1992;15(1):226-31. http://dx.doi.org/10.1016/0741-5214(92)70033-H. PMid:1728681.

37 Ktenidis K, Lioupis A, Megalopoulos A, Antoniadis K, Kiskinis D. New exposure technique for management of giant internal carotid artery aneurysm. J Vasc Surg. 2011;54(2):522-5. http://dx.doi.org/10.1016/j.jvs.2010.12.060. PMid:21377825.

38 Balagura S, Carter JB, Gossett DL. Surgical approach to the high subcranial internal carotid artery. Neurosurgery. 1985;16(3):402-5. http://dx.doi.org/10.1227/00006123-198503000-00022. PMid:3982623.

39 Buckley M, Carlson E, Heidel E, et al. Double mandibular osteotomy for access to high-carotid pathology. Ann Vasc Surg. 2021;70:202-12. http://dx.doi.org/10.1016/j.avsg.2020.08.093. PMid:32866578.

40 Kumins NH, Tober JC, Larsen PE, Smead WL. Vertical ramus osteotomy allows exposure of the distal internal carotid artery to the base of the skull. Ann Vasc Surg. 2001;15(1):25-31. http://dx.doi.org/10.1007/BF02693796. PMid:11221940.

41 Nelson SR, Schow SR, Stein SM, Read LA, Talkington CM. Enhanced surgical exposure for the high extracranial internal carotid artery. Ann Vasc Surg. 1992;6(5):467-72. http://dx.doi.org/10.1007/BF02007006. PMid:1467190.

42 Schlieve T, Carlson ER, Freeman M, Buckley R, Arnold J. The double mandibular osteotomy for vascular and tumor surgery of the parapharyngeal space. J Oral Maxillofac Surg. 2017;75(5):1046-61. http://dx.doi.org/10.1016/j.joms.2016.11.003. PMid:27923112.

43 Vikatmaa P, Mäkitie AA, Railo M, Törnwall J, Albäck A, Lepäntalo M. Midline mandibulotomy and interposition grafting for lesions involving the internal carotid artery below the skull base. J Vasc Surg. 2009;49(1):86-92. http://dx.doi.org/10.1016/j.jvs.2008.08.047. PMid:18951752.

44 Hafner L, Almeida JA, Moreno JB, et al. Aneurisma da artéria carótida interna. J Vasc Bras. 2013;12(1):40-4. http://dx.doi.org/10.1590/S1677-54492013000100008.

45 Valentini V, Fabiani F, Nicolai G, et al. Surgical approach to the third area of the internal carotid artery through vertical osteotomy of the mandibular ramus: case report. J Craniofac Surg. 2002;13(6):816-20. http://dx.doi.org/10.1097/00001665-200211000-00019. PMid:12457099.

46 Davis L, Zeitouni A, Makhoul N, Steinmetz OK. Surgical Exposure to Control the Distal Internal Carotid Artery at the Base of the Skull during Carotid Aneurysm Repair. Ann Vasc Surg. 2016;34:268.e5-8. http://dx.doi.org/10.1016/j.avsg.2015.11.016. PMid:26902936.

47 Kawanishi M, Nagasawa S, Sugie A, et al. Surgical treatment of distal cervical internal carotid artery aneurysm. Neurol Res. 1998;20(5):449-51. http://dx.doi.org/10.1080/01616412.1998.11740547. PMid:9664594.

48 Farhat-Sabet A, Aicher BO, Tolaymat B, et al. An Alternative Approach to Carotid Endarterectomy in the High Carotid Bifurcation. Ann Vasc Surg. 2020;65:240-6. http://dx.doi.org/10.1016/j.avsg.2019.10.100. PMid:31726200.

49 Ben Jmaà H, Lagha A, Diope A, et al. Surgical management of internal carotid artery aneurysm near the skull base. J Med Vasc. 2018;43(4):262-6. http://dx.doi.org/10.1016/j.jdmv.2018.04.003. PMid:29981735.

50 Bakoyiannis CN, Georgopoulos SE, Tsekouras NS, et al. Surgical management of extracranial internal carotid aneurysms by cervical approach. ANZ J Surg. 2006;76(7):612-7. http://dx.doi.org/10.1111/j.1445-2197.2006.03787.x. PMid:16813628.

51 Pennell C, Westfall S. Multidisciplinary approach to the management of an extracranial internal carotid artery aneurysm approaching the base of the skull in a young patient. Ann Vasc Surg. 2011;25(5):699.e5-8. http://dx.doi.org/10.1016/j.avsg.2010.12.032. PMid:21514103.

52 Sundt TM Jr, Pearson BW, Piepgras DG, Houser OW, Mokri B. Surgical management of aneurysms of the distal extracranial internal carotid artery. J Neurosurg. 1986;64(2):169-82. http://dx.doi.org/10.3171/jns.1986.64.2.0169. PMid:3944626.

53 Sandmann W, Hennerici M, Aulich A, Kniemeyer H, Kremer KW. Progress in carotid artery surgery at the base of the skull. J Vasc Surg. 1984;1(6):734-43. http://dx.doi.org/10.1016/0741-5214(84)90003-X. PMid:6548533.

54 Mendez-Sosa MA, Contreras-Jimenez E, Anaya-Ayala JE, et al. Surgical management of a Type II extracranial internal carotid aneurysm near to the skull base. Vasc Specialist Int. 2021;37:27. http://dx.doi.org/10.5758/vsi.210030. PMid:34349047.

55 Vang S, Hans SS. Carotid endarterectomy in patients with high plaque. Surgery. 2019;166(4):601-6. http://dx.doi.org/10.1016/j.surg.2019.06.017. PMid:31405580.

56 Kondo T, Ota N, Göhre F, et al. High cervical carotid endarterectomy-outcome analysis. World Neurosurg. 2020;136:e108-18. http://dx.doi.org/10.1016/j.wneu.2019.12.002. PMid:31830599.

57 Coll DP, Ierardi R, Mermer RW, Matsumoto T, Kerstein MD. Exposure of the distal internal carotid artery: a simplified approach. J Am Coll Surg. 1998;186(1):92-5. http://dx.doi.org/10.1016/S1072-7515(97)00132-4. PMid:9449603.

58 Michalinos A, Chatzimarkos M, Arkadopoulos N, Safioleas M, Troupis T. Anatomical considerations on surgical anatomy of the carotid bifurcation. Anat Res Int. 2016;2016:6907472. http://dx.doi.org/10.1155/2016/6907472. PMid:27047690.

59 Wongsuriyanan S, Sriamornrattanakul K. Preoperative Localization of the carotid bifurcation for cervical carotid exposure using the mastoid-hyoid line. Asian J Neurosurg. 2020;15(4):913-8. http://dx.doi.org/10.4103/ajns.AJNS_285_20. PMid:33708662.

60 Arumugam S, Subbiah NK. A cadaveric study on the course of the cervical segment of the internal carotid artery and its variations. Cureus. 2020;12(4):e7663.

61 Netter FH. Atlas de anatomia humana. Rio de Janeiro: Elsevier; 2019. p. 602.

62 Castelnuovo P, Dallan I, Tschabitscher M. Surgical anatomy of the internal carotid artery: an atlas for skull base surgeons. Berlin and Heidelberg: Springer-Verlag; 2013. p. 1-57. http://dx.doi.org/10.1007/978-3-642-29664-2.

63 Uno M, Takai H, Yagi K, Matsubara S. Surgical technique for carotid endarterectomy: current methods and problems. Neurol Med Chir (Tokyo). 2020;60(9):419-28. http://dx.doi.org/10.2176/nmc.ra.2020-0111. PMid:32801277.

64 Minter RM, Doherty GM. Current procedures surgery. New York: McGraw-Hill Education; 2010. p. 1147-70.

65 Markovic JN, Shortell CK, Rowe VL. Eversion carotid endarterectomy periprocedural care: patient preparation, monitoring & follow-up [citado 2021 set 10]. Medscape; 2020. https://emedicine.medscape.com/article/1895401-periprocedure

66 Foreman PM, Harrigan MR, Griessenauer CJ, Loukas M, Tubbs RS. Access to the carotid artery bifurcation: cadaveric study with application to nasotracheal intubation as a technique to improve access to a high carotid artery bifurcation. Br J Neurosurg. 2015;29(6):865-7. http://dx.doi.org/10.3109/02688697.2015.1071331. PMid:26312946.

67 Weiss RM, Smith HP, Smith HP, Patterson KA, Weiss RM. Patient positioning and nasal intubation for carotid endarterectomy. Neurosurgery. 1986;19(2):256-7. http://dx.doi.org/10.1227/00006123-198608000-00013. PMid:3748355.

68 Takigawa T, Yanaka K, Yasuda M, Asakawa H, Matsumaru Y, Nose T. Head and neck extension-fixation with a head frame for exposure of the distal internal carotid artery in carotid endarterectomy-technical note. Neurol Med Chir. 2003;43(5):271-3, discussion 273. http://dx.doi.org/10.2176/nmc.43.271. PMid:12790290.
 


Submitted date:
11/07/2021

Accepted date:
02/22/2022

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