MICROVASCULAR SURGERY IN HEAD AND NECK SURGERY

概要

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The extracranial carotid artery should be intentionally occluded in some situations in head and neck surgery. Tolerance for intentional carotid artery occlusion can be estimated by balloon test occlusion (BTO). During BTO, cerebral blood flow (CBF), somatosensory evoked potential, electroencephalogram, and neurological findings are usually monitored. If a patient develops any neurological deficits during BTO, the patient cannot tolerate carotid artery occlusion. In such intolerant cases, a high flow graft, such as a radial artery bypass graft, is perfomed between the external carotic artery and the middle cerebral artery, prior to intentional carotid artery occlusion. When hemispheric CBF reduction is shown in symptomatically tolerant patients, low flow revascularization, such as superficial temporal artery to middle cerebral artery anastomosis, is performed. Without CBF reduction, bypass procedures are not required.Microvascular anastomosis is performed in a jejunum autograft for esophageal reconstruction. It is important to cautiously confirm the luminal surface of the anastomosic site using an operative microscope. Suturing maneuver without sufficient microscopic confirmation should be avoided. Steadiness, remaining calm, and patience are all keys to success in microvascular anastomosis.
日本頭頸部癌学会の論文