title: Extracranial-intracranial bypass for reconstruction of internal carotid artery in the management of head and neck cancer.
abstract: Extracranial-intracranial bypass surgery was performed prior to carotid resection in eight patients with head and neck carcinoma that involved the carotid artery near the skull base. Four patients underwent the standard one-stage extracranial-intracranial bypass procedure. A two-stage procedure was performed in the remaining four patients. The procedure first involved an anastomosis between the M3 segment of the middle cerebral artery and the superficial temporal artery, followed by a bypass between the M2 segment of the middle cerebral artery and the internal carotid artery. One of the patients who underwent the standard one-stage extracranial-intracranial bypass procedure suffered an intraoperative infarction. Despite even longer occlusion times of the M2 segment, none of the patients who underwent the two-stage bypass suffered from any serious neurologic consequences. Three of seven patients who underwent the curative operations, survived more than 4 years, however, the remaining patients died within 1 year from recurrence. Our results show that carotid artery resection yields an opportunity for cure. In extracranial-intracranial bypass surgery, the temporary occlusion of the middle cerebral artery may also induce serious ischemia; however, the two-stage extracranial-intracranial bypass procedure appears to minimize the risk.
authors.affiliation: Department of Otolaryngology, Yamanashi Medical University, Yamanashi, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Chazono
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Okamoto
authors.forename: Zensei
authors.initials: Z
authors.lastname: Matsuzaki
authors.forename: Jun
authors.initials: J
authors.lastname: Ogino
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Endo
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Matsuoka
authors.forename: Tooru
authors.initials: T
authors.lastname: Horikoshi
authors.forename: Hideaki
authors.initials: H
authors.lastname: Nukui
authors.forename: Hiromu
authors.initials: H
authors.lastname: Hadeishi
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Yasui
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000601:surgery; D002343:Carotid Artery, Internal / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods*; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019043:Vascular Neoplasms / Q000556:secondary / Q000601:surgery*