Through a close cooperation between Otolaryngology, Vascular Surgery and other departments, PUMCH was the world first to complete great saphenous vein transplant and reconstruction of internal carotid artery at temporal bone segment on patients of tumors of the lateral skull base. Since July 2015, time of the first operation performed, six operations of this kind have been carried out so far, and had positive follow-up reports. The project won the third prize of 2017 Chinese Medical Science and Technology Award and second prize of PUMCH 2016 Medical Achievements Award.

Treatment of tumors that invade internal carotid artery had been a clinical headache. This kind of tumors, including carotid body tumor, carotid aneurysm and malignant tumors of the neck are mostly benign or low-grade malignant. If the tumor is totally removed, basically the patient will benefit for life, but meanwhile the internal carotid artery that is invaded might be sacrificed. According to reports, nearly 50% patients die after the removal of a single side of internal carotid artery, and 45% of the survived suffer from neurovascular complications including hemiplegia and aphasia. From the 1950s, great saphenous vein transplant and reconstruction of internal carotid artery have been successfully carried out, resulting in an obvious decline in death rate. But all previous reports were on the reconstruction of the neck segment of internal carotid artery. For tumors invading the temporal bone segment, there was still no clinical solution.

Internal carotid artery at the temporal bone segment is deeply located in the bone tube, surrounded by important cranial nerves and great vessels. Damage is easily done to cranial nerves, jugular bulb and posterior fossa, causing complications, therefore this area had long been regarded as a surgically forbidden zone. Our otolaryngologists, guided by Professor Ugo Fisch, father of modern ear nerves and lateral skull base surgery, completed systematic study of microsurgery of lateral skull base, and established a training system that reaches across China and even Asia and Africa. As a result our hospital became one of the few Chinese hospitals capable of entering from infratemporal fossa and combined procedures, therefore able to challenge the technically forbidden area.

The first patient to receive this surgery had higher located carotid aneurysm, whose upper end had reached the entrance of internal carotid artery, and the distal end of transplanted great saphenous vein was in temporal bone, and the internal carotid artery in the temporal bone segment needed to be exposed. Since there would be great risk of large-area cerebral infarction if the brain lacked blood for more than 10 minutes, the reconstruction of internal carotid artery shall be finished as soon as possible.

There were two difficulties: full exposure of the internal carotid artery in the temporal bone segment shall not cause serious complications; internal carotid artery shall be reconstructed in a tiny space and in a short time. To meet this grave challenge doctors made all possible preparations. Departments discussed each detail and the operating time was calculated by minute; simulated operations were carried out in lab to assess all possible risks; individual difference for brain blood shortage was considered and interventional procedure was made to assess the patient’s internal carotid artery conditions as a reference. Finally, otolaryngologists successfully and fully exposed the internal carotid artery in the temporal bone segment, and vascular surgeons led by Professor Zheng Yuehong used only six minutes to complete the reconstruction, making a breakthrough in this kind of procedure. Post-operation CT showed smoothness in the reconstructed internal carotid artery and good blood supply to brain. Assistant Professor Feng Guodong from Otolaryngology, one of the surgeons, said none of the six operations performed so far presented more-than-expected difficulties. The longest follow-up time was 2.5 years and all patients reported positively after being discharged.

According to Professor Gao Zhiqiang, director of Otolaryngology, the breakthrough in this procedure, and successful performance of procedures of a similar kind that followed, relied on the hospital’s multi-disciplinary team. In such procedures, Otolaryngology is responsible for fully exposing the internal carotid artery in the temporal bone segment without causing serious complications; Vascular Surgery is responsible for vessel reconstruction in a tiny space and in the shortest time possible as well as perioperative management; Neurosurgery is responsible for brain vessel emergency plans and rescue; Anaesthesiology is responsible for maintaining circulation stability and good cerebral perfusion; and ICU is responsible for post-operation vital signs recovery and stable real-time monitoring.

PUMCH’s being the world first to perform this procedure with satisfactory results marks the ability of its team centered on Otolaryngology and Vascular Surgery to deal with all kinds of diseases in which tumors of the lateral skull base invade the internal carotid artery in the temporal bone segment and the artery needs to be reconstructed. It completely broke the bottleneck of zero surgical chance for tumor in this area and only radiotherapy can be expected. The project was supported by the “Tissue Repair and Function Rebuilding in Ear Diseases” which is a part of the state’s "Twelfth Five-Year" Plan for Science & Technology Support. The results were communicated at academic conferences in Germany, South Korea and the UK, and were highly praised by international colleagues.