RESULTS OF SURGERY FOR HEAD AND NECK TUMORS THAT INVOLVE THE CAROTID-ARTERY AT THE SKULL BASE

To evaluate the results of surgery in patients with head and neck canc ers that involved the internal carotid artery at the skull base the au thors retrospectively reviewed a consecutive series of 17 patients who underwent surgery at Mount Sinai Hospital over a 4-year period. In ge neral, patients who underwent tumor resection with carotid preservatio n had less advanced disease (two of seven tumors were recurrences) tha n patients who underwent tumor resection with carotid sacrifice (seven of 10 tumors were recurrences). Of seven patients who underwent resec tion with carotid preservation, six had good outcomes (five patients a live in good condition, one dead at 2.2 years) and none had strokes. O f seven patients who underwent resection with carotid sacrifice and by pass, five had good outcomes (four alive in good condition, one dead a t 2.5 years with no local recurrence) and two suffered graft occlusion s that led to strokes, one of which was major and permanently disablin g. Of three patients who underwent resection with carotid sacrifice an d ligation without revascularization, there were no good outcomes: all three patients died within 6 months of surgery, two having suffered m ajor permanently disabling strokes. The overall results (11 [65%] of 1 7 with good outcomes at an average follow-up period of 2.1 years) comp ared very favorably with historical nonsurgical controls. The authors conclude that tumor resection with carotid perservation carries the lo west risk of stroke and should usually be the treatment of choice. For patients with more advanced and recurrent disease, in whom it is beli eved that carotid preservation would prevent a safe and oncologically meaningful resection, carotid sacrifice with carotid bypass may be a u seful treatment option. Carotid sacrifice without revascularization se ems to be the treatment option with the least favorable results.