Abstract
We performed carotid artery resection and vascular reconstruction for an advanced case of thyroid carcinoma invading the left carotid artery. Preoperatively, we performed small cranial fenestration (burr hole) surgery in the left temporal region above the zygomatic arch to make an acoustic window for transcranial Doppler (TCD) and a carotid occlusion test (TCD guided Matas'test) was performed. Though this test showed collateral circulation was sufficient, vascular reconstruction was performed considering the effect of cerebral hemodynamics. Total thyroidectomy, total laryngectomy, partial pharyngectomy, neck dissection at both sides and resection of the left common carotid artery and internal carotid artery were performed. Furthermore, contralateral external carotid-ipsilateral internal carotid artery bypass grafting was performed using a saphenous vein graft. INVOS 4100 is very useful for monitoring cerebral circulation in real time. No serious central nervous system complications, including hemiplegia, were observed and no local recurrence and metastasis were found in this patient.
