Management of penetrating injuries of the internal carotid artery at the base of the skull utilizing extracranial-intracranial bypass

Penetrating injuries of the internal carotid artery at the base of the skull often require permanent or transient occlusion of the injured vessel during repair. Extracranial-intracranial bypass (EC-IC) was employed in five patients to insure adequate cerebral perfusion during cervical exploration. Preoperative neurologic deficits were noted in three patients; two demonstrated complete reversal following EC-IC. This experience suggests that EC-IC can maintain adequate cerebral perfusion during repair of internal carotid injuries and allow selective revascularization of patients with neurologic deficit and carotid occlusion.