Common carotid artery epicranial sympathetic nerve net stripping for pediatric cerebral palsy

  Cerebral palsy (CP) is a condition in which brain tissue is damaged before, during, or after birth, presenting a fixed non-progressive lesion that can occur in various parts of the brain, and the mechanisms that produce it are still not well understood. The clinical manifestations are complex and may include epilepsy, mental retardation, speech disorders, strabismus, salivation, hearing loss, limb movement disorders, and incoordination. There are many treatment measures, but there is still no ideal treatment method. In the treatment of cerebral palsy, the sympathetic nerve network around the common carotid artery was removed and the patient’s speech function, salivation and limb function were improved to different degrees. The main cause of salivation in children with cerebral palsy is that the brain tissue of the child is damaged during the immature stage of development, resulting in a non-progressive and irreversible lesion, which causes neuromuscular atrophy in the corresponding functional area and dysfunction of oral muscle motor coordination, resulting in abnormal swallowing function and inability to clear oral saliva. 1) After stripping the sympathetic nerve network of the common carotid artery, the blood vessels in the brain can be dilated, the blood supply to the brain can be increased, the symptoms of ischemia and hypoxia in the brain tissue can be improved, the collateral circulation can be established, the function of some neuronal cells in the critical state can be restored, and the compensatory function of the brain tissue can be improved, so that the swallowing movement and the coordination function of the oral sphincter can be improved through central regulation and salivation can be reduced.   2) The salivary glands are innervated by sympathetic nerves and linguopharyngeal nerves. The sympathetic nerves innervating the salivary glands originate from the lateral horn of the gray matter of the thoracic segment of the spinal cord and send out postganglionic fibers after nerve exchange in the superior cervical ganglion. The surgical stripping of the common carotid artery epicardium blocked the sympathetic conduction, and the direct innervation effect of the sympathetic nerve was diminished, and the secretion of saliva was reduced.   In addition, due to the reduced excitability of the sympathetic nerves in the neck, the surgery also results in decreased muscle tone, improved coordination, enhanced positioning ability, and clearer and more coherent spitting in the upper limbs of children with cerebral palsy. At the same time, the surgery can also improve the patient’s combined symptoms such as intellectual language disorder, strabismus, swallowing and feeding difficulties, ataxia, and tardive dyskinesia to varying degrees.   Through our clinical practice, we found that the overall efficiency of surgical treatment for children with cerebral palsy was divided into three age groups: under 3 years old, 3-5 years old, and over 5 years old, and the overall efficiency of surgery to improve salivation symptoms tended to decrease with increasing age. Therefore, we currently advocate that the best time for surgery is from 6 months to 6 years old. The younger the child is, the better the treatment will be for rehabilitation, especially for language rehabilitation, because before six years old is the critical period for language development in children.