Dissection Methods and Routine Steps in Microsurgical Carotid Endarterectomy

Abstract

The routine steps described herein are essential for safe carotid endarterectomy (CEA). We considered performing microsurgical CEA with routine methods is effective on education. Our surgical method is as follows: The microscope is introduced through a skin incision. The cervical fascia is dissected along the anterior margin of the sternocleidomastoid muscle. The submandibular space is widely opened by subluxation of the mandibular. The distal internal carotid artery is exposed by dissection around the hypoglossal nerve by cutting the sternocleid artery. The carotid sheath is opened just above the carotid artery and pulled up with hooks. The plaque is removed through interintimal dissection without tacking sutures at the distal edge. Of 144 procedures, ischemic complications were recorded in three cases and peripheral nerve palsy was recorded in one case. The dissection methods were divided into three categories by analyzing the surgical videos recorded by using high-vision microscopy. The first method is dissection between the membranes, the second method is opening a tiny space around the vessels and nerves, and the third method is making a dissection plane without membranes. This categorization of dissection methods is also applicable to brain surgery. CEA is performed by using routine steps; hence, a trainee can easily acquire the microsurgical techniques. Microsurgical CEA is considered to be useful in microsurgical education of young neurosurgeons.