Abstract
A 4-year-old right handed boy was admitted with the left hemiparesis of sudden onset. Angiographic studies demonstrated kinking of the bilateral internal carotid arteries and right vertebral artery in the neck portion. On rotating the neck to the right, the kinked segment of the right carotid artery was rendered more stenotic. Computerized tomography and electroencephalography were normal. Reconstructive surgery of the right internal carotid artery including an end to side anastomosis between the internal carotid artery and the common carotid artery was performed to prevent cerebral atrophy or stroke. Eleven months postoperatively, the left hemiparesis had disappeared and he remained free of symptoms. Various methods of surgical correction for carotid coiling, tortuosity, kinking or stenosis have been reported for adults. In four children, Suzuki et al. did not amputate the internal carotid artery, but fixed its coiled portion to the external carotid artery. In the present case, mannitol was used to overcome the risk during the reconstructive operation of the internal carotid artery at its bifurcation.
Reconstructive surgery may be possible even in children and is safe and effective in selective cases.
