The Unusual Origin of the Sternocleidomastoid Artery from the Lingual Artery

The sternocleidomastoid (SCM) artery supplying blood to the SCM muscle has different origins according to its anatomical segment. The authors performed cadaveric neck dissection to review the surgical anatomy of neurovascular structures surrounding the carotid artery in the neck. During the dissection, an unusual finding was cited in which the SCM artery supplying the middle part of the SCM muscle originated from the lingual artery (LA); it was also noted that it crossed over the hypoglossal nerve (HN). There have been extremely rare reports citing the SCM artery originated from the LA. Though the elevation of the HN over the internal carotid artery was relatively high, the vascular loop crossing over the HN was very close to the carotid bifurcation. Special anatomical consideration is required to avoid the injury of the HN during carotid artery surgery.

Anesthetic Management for Reconstructive Carotid Surgery Using of Electroencephalography / 대한마취과학회지

A 39 years old, ASA PS I. healthy female patient was scheduled for surgical resection of a paraganglioma surrounding right carotid artery bifurcation area. Anesthesia was induced with thiopental and sucinylcholine and maintained with 0.75-1.25 Vo1% halothane in 50% nitrous oxide in oxygen. Reconstructive carotid artery surgery with intraluminal shunt was performed due to laceration of carotid artery bifurcation area during wide dissection of tumor mass. Duration of the carotid artery clamp and release was 35 minutes and any significant changes in vital signs and EEG were not found. Soon after the patient was recovered from anesthesia. She was delivered to recovery room and then she was transferred to intensive care unit. She was discharged from hospital without any neurologic sequelae on the 13th postoperative day.

Anesthetic Management for Carotid Artery Surgery with a Temporary Indwelling Shunt / 대한마취과학회지

A 24 years old female patient presented for surgical resection of a large chemodectoma with extensive involvement of the bifurcation of the left common carotid artery. Anesthesia was induced with thiopental and maintained with 0.75~1.25% halothane with 50% nitrous oxide in oxygen. Arterial blood pressure and carbon dioxide tension were maintained at preoperative levels with a direct arterial pressure monitoring device and an ABM end-tidal carbon dioxide monitoring device. Thiopental was infused continuously by a microinfusion pump(2mg/kg/hr) during the procedure and an intraluminal shunt was inserted in the left internal carotid artery to protect the brain form hypoxic attack. Body temperature was monitored and electrocardiography and electroencephalography were also applied. No significant changes in vital signs and electroencephalgraphy during anesthesia were noted with the exception of a temporary decreas in blood pressure due to bleeding from the accidental perforation of the left internal carotid artery. The patient responded soon after the withdrawal of anesthesia and she was discharged from hospital with an uneventful recovery on the seventh postoperative day. A reduction in cerebral blood flow without a concomitant reduction in cerebral metabolic rate during carotid arterial procedures may result in significant neurologic derangements. Therefore, the major role of the anesthesiologist is the maintenance of adequate oxygen delivery to the brain and the reduction of cerebral metabolic demands.