INTERNAL CAROTID-ARTERY SACRIFICE FOR RADICAL RESECTION OF SKULL BASETUMORS

When dealing with skull base tumors that encase the internal carotid a rtery (ICA), the surgeon must decide between ICA preservation and inco mplete tumor resection, or radical resection with ICA sacrifice. In ou r experience with more than 300 anterior skull base tumors, the ICA wa s sacrificed in only 10 patients. These tumors were malignant except f or one meningioma that occluded the ICA and produced transient ischemi c symptoms. All patients had the ICA resected with the tumor, and all patients underwent revascularization (cervical ICA-MAC saphenous bypas s, n = 4; cervical-to-supraclinoid bypass, n = 1; petrous-to-supraclin oid bypass, n = 3; bonnet bypass, n = 2). The small patient series ref lects our practice of preserving the ICA whenever possible. We recomme nd preserving the ICA with benign tumors because they do not invade th e artery, or do so only to a limited extent. In addition, similar rate s or tumor recurrence are seen after aggressive resection with or with out ICA sacrifice. In contrast, we recommend radical tumor resection a nd sacrifice of the ICA with malignant tumors because they directly th reaten the integrity of the ICA and the patient's survival. The ICA sh ould not be considered a limitation to radical tumor resection because the ICA can be reconstructed safely with an appropriate bypass proced ure.