Mh. Brisman et al., RESULTS OF SURGERY FOR HEAD AND NECK TUMORS THAT INVOLVE THE CAROTID-ARTERY AT THE SKULL BASE, Journal of neurosurgery, 86(5), 1997, pp. 787-792
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.