METHOD FOR DIRECT BRAIN REVASCULARIZATION IN CASE OF MALIGNANT HEAD AND NECK MALIGNANCES WITH INVOLVEMENT OF THE INTERNAL AND EXTERNAL CAROTID ARTERIES Russian patent published in 2021 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgery and oncology. An arcuate incision of the neck skin, subcutaneous fatty tissue, subcutaneous muscle of the neck from the mastoid process to the jugular notch of the sternum is performed. Skin flaps are taken on holders and separated: the upper flap - to the level of the lower jaw branch, lower - to the clavicle, laterally - to the edge of the trapezius muscle. Next, the fascial sheath of the sternocleidomastoid muscle is opened and taken on the holder. After that, the scapular-clavicular muscle is isolated and transected at the level of the outer edge of the sternocleidomastoid muscle. The fascial sheath of the neurovascular bundle of the neck is opened: the common carotid artery, the internal carotid artery, the external carotid artery, the internal jugular vein and the vagus nerve - they are taken on holders and hemostasis is performed. Fiber of I-V levels of the neck is mobilized and removed as a single block with metastatic nodes, internal jugular vein, sternocleidomastoid muscle, a fragment of the internal carotid artery, and the external carotid artery is cut off in the area of ​​bifurcation of the common carotid artery. Hemostasis is performed, restoration of retrograde blood flow is noted. After that, vascular clips are applied to the arteries and a 4.5 cm long fragment of the right facial artery is isolated under optical magnification and a free autoarterial graft is formed from the peripheral facial artery with its outer diameter of at least 3 mm. Further, the facial artery is separated on the side of the lesion of the internal carotid artery, which is mobilized in the carotid and submandibular triangles, isolated from the submandibular salivary gland, after which the latter is removed. Next, the proximal end of the facial artery is crossed at the level of the origin of the external carotid artery. The distal end of the facial artery is transected at the level of the lower edge of the mandibular ramus. After that, an anastomosis is applied to the distal and proximal sections of the internal carotid artery according to the “end-to-end” type, and in the presence of blood flow in the internal carotid artery and vascular graft, the wound is sutured in layers.

EFFECT: method allows restoring the intracranial (intracerebral) main blood flow using a free arterial autograft after resection of the internal carotid artery in case of its involvement in the tumor process and, ultimately, to ensure an adequate neurological status of the patient in the postoperative period.

1 cl, 6 dwg, 1 ex