Treatment of ICA in the extirpation of carotid body tumor

概要

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Treating patients with carotid body tumor occasionally requires permanent occlusion of the internal carotid artery. In this paper, we report two cases with some problems in dealing with the internal carotid artery in the operation. To determine the indication of ligation of internal carotid artery (ICA), we usually try balloon occlusion test and measure stump pressure and cerebral blood flow (CBF) with studying EEG, neurological findings, and collateral circuration. One case was a 53-year-old woman. We could extirpate the carotid body tumor in the subadventitial plane. After the extirpation we found subadventitial-hematoma-like change. It did not increase in size and we left it. She had no problem after the operation. The other case was a 41-year-old man. When we were resecting the carotid body tumor, the wall of ICA was lacerated. We sutured the wall by 7-0 nylon. 48hours after the operation, he complained upper left quadrantic hemianopsia. We studied brain CT and found brain infarction in right posterior lobe. We could not determine it was because of thrombosis of posterior cerebral artery from the suture of ICA or decrease of blood flow. We think 1) wash-out of thrombus before finishing the suture of ICA and 2) heparinization during and after the operation 3) ligation of ICA and 4) more detailed examination of preoperative angiography and etc. are necessary.
特定非営利活動法人日本頭頸部外科学会の論文