| 摘要 |
FIELD: medicine.SUBSTANCE: cervical neurovascular bundle is accessed from a standard anterolateral skin incision along an anterior border of a sternocleidomastoid muscle. An internal jugular (IJ) is mobilised in the distal direction. An accessory nerve is separated. An intersection of the accessory nerve and internal jugular lies in a projection of C1 neural spine palpated and is an access apex. Anterior bundles of the muscles elevating a shoulder blade in C1-C2 transversal neural spines are separated and transected, and an anterior branch of C3 spinal nerve is exposed. A vertebral artery is visualised and mobilised under the spinal nerve. The spinal nerve and vertebral artery are held in sutures. The vertebral artery is mobilised below C3 neural spine by resection of the anterior wall of C4 neural spine and separation it up to a point wherein it escapes from C5 neural spine canal. The cervical access is combined with taking a fragment of a long saphenous vein 9-11 cm long, used as a by-pass. A distal portion of the vertebral artery is underrun, ligatured and transected along a point wherein it escapes from C2 neural spine canal. That is followed by creating an end-to-end distal anastomosis with the pre-separated autovein. A test start of the blood flow is initiated. The vertebral artery is underrun, ligatured and transected in the proximal direction from a point wherein it escapes from C3 neural spine canal. An end-to-end proximal anastomosis with a brought-down autovein is formed. The test start of the blood flow is initiated. If the sutures occur to be leak-proof, the artery is unclamped, an aneurismal cavity is opened to inspect if it is excluded radically from the blood flow.EFFECT: method enables providing the higher clinical effectiveness ensured by the lower risk of haemorrhaging aneurism rupture and vertebral artery thrombosis.1 ex, 2 dwg |
