title: Surgical management of lesions of the internal carotid artery using a modified Fisch type A infratemporal approach.
abstract: OBJECTIVE
  To report seven cases of vascular repair of the internal carotid artery (ICA) using a modified Fisch type A infratemporal approach and a venous grafting.
  
  
  METHODS
  Retrospective case review.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  We have analyzed the clinical presentation, paraclinical assessment, and postoperative results regarding the vascular repair and the facial and auditory function from seven consecutive patients. All patients have been operated on by a multidisciplinary team of ENT and vascular surgeons.
  
  
  RESULTS
  The study includes four men and three women, aged from 21 to 62 years old. Six patients suffered from vascular traumatic injury after motor vehicle accident (n = 5) or cervical manipulation (n = 1) and one patient presented an atheromatous stenosis. All benefited from a vascular repair with a venous grafting through a modified Fisch Type A infratemporal approach. No death and no new stroke were noted (mean follow-up, 34 mo). The postoperative angiographies showed six functional grafts and one asymptomatic thrombosis. Six immediate postoperative facial palsy occurred but recovered to Grade I or II within 6 months. There was one traumatic injury of the facial nerve and one postoperative anacusis. For the six other patients, the reconstitution of the external auditory canal and ossicular chain allowed to limit the hearing loss to a mean air-bone gap of 22.5 dB (range, 15-35 dB).
  
  
  CONCLUSIONS
  The lesions of the intrapetrous aspects of the ICA remain the subject of debates regarding the indication for a vascular repair. For young or in good health patients, the infratemporal approach provides a safe and reliable access to the horizontal segment of the ICA, offering to the vascular surgeons optimal conditions for the vascular repair.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Hôpital Universitaire Nord, Marseille, France. arnaud@deveze.org
authors.forename: Arnaud
authors.initials: A
authors.lastname: Devèze
authors.forename: Yves
authors.initials: Y
authors.lastname: Alimi
authors.forename: Laurent
authors.initials: L
authors.lastname: Tardivet
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Lavieille
authors.forename: Jacques
authors.initials: J
authors.lastname: Magnan
mesh_terms: D000328:Adult; D000792:Angiography; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013506:Otologic Surgical Procedures / Q000379:methods*; D010348:Patient Care Team; D012189:Retrospective Studies; D013701:Temporal Bone / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods*