On the advisability of surgical treatment of children with kinking of the internal carotid artery.
The aim of the present work was to evaluate the long-term results of surgical treatment of children with pathological kinking of the internal carotid artery (PK ICA). Fifty children (42 boys and 8 girls) aged 5 to 16 years (range 11.1+/-0.32) with PK ICA were operated on. PK ICA was diagnosed by color duplex scanning (CDS) using the apparatus <<Spectra Masters>> (Diasonics, USA) and was confirmed by angiography. The majority of operations were performed on the right ICA (n=29) whereas 18 operations on the left one. Three children were operated on from both sides. Two types of correction were accomplished: resection of the proximal segment of the ICA (5 to 18 mm) with replantation to the old orifice was made on 34 arteries; 19 patients underwent ICA arteriolysis. The predominant clinical symptoms in children with PK ICA manifested by cerebrovascular insufficiency; 4 cases presented with transient disorders of cerebral circulation, and one child had a history of ischemic stroke. The follow-up constituted 3 to 10 years (mean 7.1+/-2.3). All the patients were under childhood neurologist's observation before and after operation, with the performing of a complex of neurophysiological procedures. It has been established as a result that in children with PK ICA arteriolysis appeared ineffective. The positive clinical result of surgical correction of PK ICA was recorded in the long-term period (3 to 10 years) after resection of the proximal segment of the ICA with replantation to the old orifice. This operation was effective in all patients with transient disorders of cerebral circulation: headache, nausea, vomiting, syncopal conditions and paroxysmal sleep disorders practically disappeared. In the presence of epileptic syndrome, the positive result could be achieved only in patients with brachiofacial attacks. No dynamics was recorded in partial and generalized attacks. On the whole in the group, surgical intervention eventuated in an improvement of cerebral flow according to the data supplied by color duplex scanning. However, the recurrence of PK ICA was recorded in 9.6% of cases. The bioelectrical activity of the brain and cognitive evoked potentials improved in the third of the operated patients with PK ICA. In half the cases, the function of the central motoneuron and optic tract was found to be restored.
Altai Branch of the State Establishment, Research Institute of Physiology, Siberian Branch, RAMS, Barnaul, Russia. ksmirnoff@yandex.ru
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Smirnova
D000293:Adolescent; D001921:Brain / Q000098:blood supply; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D002560:Cerebrovascular Circulation / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D000075202:Contraindications; D005260:Female; D006801:Humans; D008297:Male; D018615:Ultrasonography, Doppler, Color; D014656:Vascular Surgical Procedures