2018 Volume 23 Issue 1 Pages 49-53
The neck clipping of a large aneurysm of the internal carotid artery (ICA) or a para‒clinoid aneurysm may require flow control achieved by manipulation of the cervical ICA. However, the height of the carotid bifurcation is reported to be one vertebral body‒length higher in Japanese compared to Caucasian patients. Neurosurgeons in Japan are thus more likely to encounter a high‒position ICA, which is difficult to dissect. Herein we describe the safe and cosmetic method that we use for securing the cervical ICA during aneurysm clipping. For Japanese patients with a high‒position ICA, the head is placed in a suitable position for clipping. The pillow that is usually used for the elevation of the ipsilateral shoulder is not used to create tension in the cervical skin. The skin incision follows the skin wrinkle just above the thyroid cartilage, which usually points to the mastoid tip. The transverse skin incision is initiated at 2 cm medial from the anterior border of the sternocleidomastoid muscle and extended posteriorly to 5 cm length. The skin flap is then formed along the great auricular nerve to reach the anterior border of the sternocleidomastoid muscle. The posterior belly of the digastric muscle is dissected as far as possible. The carotid triangle is identified and the bifurcation is dissected to reveal the ICA. We have performed this method in 20 patients. No episodes of cranial nerve palsy, including the facial nerve, recurrent nerve, and hypoglossal nerve, were observed after the surgery. A transverse skin incision for cervical carotid artery dissection can thus achieve good cosmetic results.
