Human brain development depends heavily on an adequate blood supply to ensure that oxygen and nutrients can be effectively delivered to every neuron. This is especially important in early childhood, when the brain is in a critical stage of rapid growth and neural network formation.

There are two pairs and four arteries that supply blood to the human brain: the common carotid artery, the vertebral artery, the posterior cerebral artery, and the anterior cerebral artery.

Carotid periarterial sympathectomy (CPS) strips the adventitia of the carotid artery, “unbinding” narrowed blood vessels and providing impetus for slowly developing brain function. Therefore, this procedure can effectively “accelerate” the rehabilitation of children with cerebral palsy and brain disorders, thereby helping them improve conditions such as language developmental disorder, cognitive delay, and hyperactivity.

Xiao Jin is seven years old. When he was just over three years old, he experienced language regression. This puzzled and worried his family, who took him to a local hospital. Examination suggested developmental delay and autism. After intermittent rehabilitation intervention, the results were not ideal.

His family decided to bring Xiao Jin from Shaanxi to Shenzhen to seek more professional treatment at the Department of Neurosurgery of Shenzhen Overseas Chinese Hospital.

Professor Xiao Hong, Director of the Department of Neurosurgery at Huiya Hospital of the First Affiliated Hospital of Sun Yat-sen University and Director of the Department of Minimally Invasive Neurosurgery at Shenzhen Overseas Chinese Hospital, received the patient and carefully assessed Xiao Jin’s condition. He learned that although Xiao Jin could communicate simply, his pronunciation was unclear, his vocabulary was limited, and his expressive ability was poor. Socially, he had the willingness to interact but lacked communication skills. His cognition and logical thinking were also markedly delayed, and his behavior was somewhat immature. In class, he had difficulty sitting still. When excited, he often spun in circles and flapped his hands, talked to himself, and giggled, but showed no self-injurious behavior. He was diagnosed with brain hypoplasia and speech and language developmental disorder.

The multidisciplinary expert team of the Department of Neurosurgery, together with Professor Xiao Hong, formulated an individualized comprehensive treatment plan for the child, including medication, surgical intervention, and systematic speech training.

For surgery, carotid periarterial sympathectomy (CPS) was considered. This procedure can dilate the common carotid artery, internal carotid artery, and intracranial arteries, increase intracranial cerebral blood flow, and improve the child’s cerebral blood supply, thereby improving conditions such as language developmental disorder, cognitive delay, and hyperactivity.

During surgery, Professor Xiao Hong operated precisely, circumferentially incising the adventitia of the common carotid artery for 2–3 cm under a microscope and stripping the perineural connective tissue to ensure smooth blood flow.

After successful surgery, combined with rehabilitation treatment, Xiao Jin showed the following changes in just seven days: he could now sit quietly, talked to himself much less, and his tendency to become easily excited had also changed. In less than a week of treatment, Xiao Jin’s self-control and hyperactivity improved significantly, to the relief of his family.

“The child is much quieter after surgery, and his self-talk has decreased a lot. He used to mumble and repeat things constantly; now he can sit quietly and does not get excited so easily. In the past, he would keep shouting and flapping his hands,” his family shared with Professor Xiao Hong about Xiao Jin’s changes during treatment at the Brain Center.

These changes in Xiao Jin further demonstrate the effectiveness of carotid periarterial sympathectomy (CPS). His family is full of confidence in the treatment effect and looks forward to more progress in his subsequent rehabilitation.

Professor Xiao Hong stated that surgery is the foundation and, even more, the key to treating cerebral palsy and brain disorders. Although carotid periarterial sympathectomy can produce immediate results and greatly shorten the child’s rehabilitation time, the effects of rehabilitation treatment should not be ignored. Surgical treatment and rehabilitation treatment complement each other. Postoperative rehabilitation training is equally important and must be sustained.

Understanding Carotid Periarterial Sympathectomy

01 Principle of Carotid Periarterial Sympathectomy

By removing the sympathetic nerve network around the carotid artery, the common carotid artery, internal carotid artery, and intracranial arteries can be dilated, intracranial cerebral blood flow can be increased, cerebral blood circulation can be improved, and the establishment of collateral circulation can be promoted. This allows some borderline neurons to recover function to varying degrees, promotes brain development, and comprehensively improves patients’ brain function.

02 Indications for Carotid Periarterial Sympathectomy

(1) Torsion spasm, language impairment, and intellectual disability caused by cerebral palsy

(2) Spastic paralysis with tension, clumsiness of hands and feet, unsteady walking, and drooling

(3) Spastic paralysis caused by kernicterus, ataxia, hyperactivity, etc.

03 Surgical Procedure of Carotid Periarterial Sympathectomy

Under general anesthesia with endotracheal intubation, longitudinal incisions about 3 cm long are made along the middle-lower medial border of the bilateral sternocleidomastoid muscles. The skin, platysma, and anterior cervical fascia are incised to expose the carotid sheath. The space between the common carotid artery and the internal jugular vein is separated. Then, under a microscope, the adventitia of the common carotid artery is circumferentially incised for 2–3 cm, and the perineural connective tissue is removed.

04 Surgical Efficacy of Carotid Periarterial Sympathectomy

By improving cerebral blood supply in children with cerebral palsy, promoting brain development, reducing the release of excitatory neurotransmitters in the brain, and regulating nerve excitability, CPS can comprehensively improve brain function, enhance intelligence, memory, and language ability, and reduce limb muscle tone, especially in the upper limbs.