Abstract
Background: The purpose of this study was to review the outcome of patients who had cranial and
cervical nerve injuries after carotid endarterectomy (CEA). Methods: This prospective study reviewed 200 consecutive CEAs. Preoperative and postoperative
cranial nerve assessment was completed on all patients. Neurologic evaluation included
routine direct fiberoptic laryngoscopy. Patients found to have no neurologic injury
had no further follow-up. Patients with postoperative peripheral neurologic dysfunction
were enrolled for regular long-term follow-up to assess delayed recovery. Results: Overall, 25 (12.5%) nerve injuries were identified in 24 patients. There were 11
(5.5%) hypoglossal, 8 (4%) recurrent laryngeal, 2 (1%) superior laryngeal, 2 (1%)
marginal mandibular, and 2 (1%) greater auricular nerve injuries. None of the patients
were lost to follow-up. All nerve dysfunctions were transient, with all but 4 nerves
recovering completely within 6 months. The recovery took from 1 week to 37 months,
with a mean recovery time of 5.8 months. Two patients with recurrent laryngeal nerve
dysfunction were found to have prolonged full recovery time (ie, 31 and 37 months,
respectively). Two patients successfully underwent contralateral CEA, although movement
of the opposite vocal cord was not fully restored. Conclusions: Cranial nerve injury after CEA is a common occurrence and can be classified as a
“major” or “minor” complication, depending on the severity of the clinical consequences.
Extended follow-up will identify the specific subset of patients with a late complete
nerve recovery. (Surgery 1999;125:85-91.)
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Factors in the mortality and morbidity associated with surgical treatment of cerebrovascular insufficiency.Circulation. 1969; 39: 269-274
- The hypoglossal nerve in carotid arterial reconstructions.Stroke. 1972; 3: 576-578
- Cranial nerve injury during carotid endarterectomy.Ann Surg. 1977; 185: 192-195
- Hazards and safeguards during carotid endarterectomy.Am J Surg. 1977; 133: 458-462
- Complications of carotid endarterectomy.Surg Clin North Am. 1983; 6: 1293-1302
- Cranial nerve paralysis following carotid endarterectomy.Stroke. 1984; 15: 157-159
- Injury of the peripheral cranial nerves during carotid endarterectomy.Stroke. 1985; 16: 894-895
- Accessory nerve injury during carotid endarterectomy.J Vasc Surg. 1987; 5: 440-444
- Glossopharyngeal nerve injury complicating carotid endarterectomy.J Vasc Surg. 1987; 5: 469-471
- Cranial nerve injuries during carotid endarterectomy.Am J Surg. 1987; 154: 529-532
- Cranial nerve injuries after carotid artery endarterectomy.South Med J. 1988; 81: 1006-1009
- Cranial nerve injuries following carotid endarterectomy: an analysis of 336 procedures.Head Neck. 1991; 13: 121-124
- A prospective study of the incidence of injury to the cranial nerves during carotid endarterectomy.Surg Gynecol Obstet. 1980; 151: 781-784
- Motor speech malfunction following carotid endarterectomy.Surgery. 1981; 89: 56-59
- Motor speech deficit following carotid endarterectomy.Ann Surg. 1982; 196: 461-464
- Cranial and cervical nerve damage associated with carotid endarterectomy.Br J Surg. 1983; 70: 365-368
- Local neurological complication following carotid endarterectomy.J Cardiovasc Surg. 1988; 29: 432-436
- Cranial nerve injuries after carotid artery surgery: a prospective study of 663 operations.Eur J Vasc Endovasc Surg. 1995; 10: 445-449
- Cranial/cervical nerve dysfunction after carotid endarterectomy.J Vasc Surg. 1997; 25: 481-487
- The rationale for patch graft angioplasty after carotid endarterectomy: early and long-term follow-up.Stroke. 1984; 15: 972-979
- Carotid eversion endarterectomy and reimplantation: a safe and simple technique to prevent acute thrombosis-occlusion and/or early and late restenosis.Cardiovasc Surg. 1997; 5: 473-480
- Progress in carotid artery surgery at the base of the skull.J Vasc Surg. 1984; 1: 734-743
- Extralaryngeal division of recurrent laryngeal nerve: surgical and clinical significance.Am J Surg. 1982; 144: 466-469
- Early complications of carotid surgery.Int Surg. 1984; 69: 223-229
- Avoidance of postcarotid endarterectomy hypertension.Ann Surg. 1982; 196: 465-472
Article info
Publication history
Accepted:
July 14,
1998
Footnotes
☆Supported in part by grant 638/02/96, Progetto di Ricerca Sanitaria Finalizzata della Regione Veneto, Giunta Regionale Veneta, Venice, Italy.
☆☆Reprint requests: Enzo Ballotta, MD, Vascular Surgery Section, First Institute of General Surgery, University of Padua, School of Medicine, Policlinico Universitario, Via N Giustiniani, 2 35128 Padova, Italy.
Identification
Copyright
© 1999 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
