Microsurgical flow reconstruction targeting adventitial layer for long-segment cervical ICA tubular stenosis accompanying with distal grade 2 or 3 kinking: Clinical outcomes of 19 cases

Objective: To evaluate the efficacy of perivascular sympathectomy in managing long-segment tubular stenosis of the cervical segment (C1) internal carotid arteries (ICAs) accompanying Grade 2 or 3 kinking distally. Due to the lesion's deep and distal location, conventional medical and endovascular interventions and proximal to distal anastomosis or bypass procedures may not be viable options for this condition.

Methods: We retrospectively analyzed the clinical outcomes of 19 patients (10 males, 9 females; age range 43–66 years) who underwent perivascular sympathectomy for long-segment (>5 cm) tubular stenosis of the cervical ICA, co-occurrence with distal Grade 2 or 3 kinking, between 2017 and 2022. The authors investigated the symptoms such as hemiparesis, motor dysphasia, focal epileptic seizures, tinnitus, and migraine attacks associated with transient ischemic attacks (TIAs) pre- and postoperatively at the 1,3,6,12,24 month follow-up. Radiological assessment and follow-up were conducted using MR/CT angiography and CT/MR perfusion studies. Paired t-tests were used to compare preoperative and postoperative measurements. Significance was set at p<0.05. Analyses were performed using SPSS version 26.0.

Results: Postoperatively, 8 out of 9 migraine sufferers (88.9%) reported complete cessation of symptoms, while one patient (11.1%) experienced a reduction in frequency and intensity. In cases of epileptic seizures, 5 out of 6 patients (83.3%) reported complete resolution, with one patient (16.7%) experiencing reduced seizures. All 15 patients (100%) with initial hemiparesis (40–50% loss of motor function) and 8 with motor dysphasia showed complete recovery postoperatively. Additionally, 8 out of 10 patients (80%) with tinnitus showed significant improvement, while two (20%) reported no change. No TIA attacks were observed among the patients during the mean two-year follow-up period.

Conclusion: Adventitia layer-focused arteriolysis and perivascular sympathectomy have demonstrated promising results in alleviating symptoms and preventing recurrent cerebrovascular events in this cervical ICA pathology. These findings support the potential of this procedure as an effective treatment option for this challenging vascular condition.

He completed his medical education at Hacettepe University, School of Medicine in 1986. He then pursued his residency training in Neurosurgery at Ankara University, Avicenna Hospital, completing it in 1992. During this period, he had the opportunity to train under renowned experts in vascular and functional neurosurgery, which greatly shaped his professional development.

In 2009, he was promoted to the academic rank of Professor in Neurosurgery. Subsequently, he earned a PhD in Anatomy in 2011, further deepening his understanding of neuroanatomical structures and functions.

Today, in addition to performing standard neurosurgical procedures, he specialize in vascular and functional neurosurgical operations. These procedures aim to restore lost or impaired neurological functions, often providing significant improvements in patients' quality of life.

He have over 1500 citations in journals listed in SCI (Science Citation Index) or SCI-Expanded.

Using new techniques in the treatment of carotid and vertebrobasilar insufficiency, he have operated on more than 200 patients (83 with carotid and 122 with vertebrobasilar insufficiency). We have identified a novel etiopathogenetic factor in carotid insufficiency, which has been published in the journal Brain Sciences.