Carotid Endarterectomy and Cranial Nerve Injuries

2003 ◽  
pp. 245-252
Author(s):  
C. D. Liapis ◽  
J. D. Kakisis
Keyword(s):  
Carotid Endarterectomy ◽  
Cranial Nerve ◽  
Nerve Injuries ◽  
Cranial Nerve Injuries

Risk of persistent cranial nerve injury after carotid endarterectomy

2004 ◽  
Vol 101 (3) ◽  
pp. 445-448 ◽  
Author(s):  
Edwin J. Cunningham ◽  
Rick Bond ◽  
Marc R. Mayberg ◽  
Charles P. Warlow ◽  
Peter M. Rothwell
Keyword(s):  
Carotid Endarterectomy ◽  
Nerve Injury ◽  
Cranial Nerve ◽  
Nerve Injuries ◽  
Content Type ◽  
Before And After ◽  
Cranial Nerve Injury ◽  
Cranial Nerve Injuries ◽  
Fine Print

Object. Cranial nerve injuries, particularly motor nerve injuries, following carotid endarterectomy (CEA) can be disabling and therefore patients should be given reliable information about the risks of sustaining such injuries. The reported frequency of cranial nerve injury in the published literature ranges from 3 to 23%, and there have been few series in which patients were routinely examined before and after surgery by a neurologist. Methods. The authors investigated the risk of cranial nerve injuries in patients who underwent CEA in the European Carotid Surgery Trial (ECST), the largest series of patients undergoing CEA in which neurological assessment was performed before and after surgery. Cranial nerve injury was assessed and recorded in every patient and persisting deficits were identified on follow-up examination at 4 months and 1 year after randomization. Risk factors for cranial nerve injury were examined by performing univariate and multivariate analyses. There were 88 motor cranial nerve injuries among the 1739 patients undergoing CEA (5.1% of patients; 95% confidence interval [CI] 4.1–6.2). In 23 patients, the deficit had resolved by hospital discharge, leaving 3.7% of patients (95% CI 2.9–4.7) with a residual cranial nerve injury: 27 hypoglossal, 17 marginal mandibular, 17 recurrent laryngeal, one accessory nerve, and three Horner syndrome. In only nine patients (0.5%; 95% CI 0.24–0.98) the deficit was still present at the 4-month follow-up examination; however, none of the persisting deficits resolved during the subsequent follow up. Only duration of operation longer than 2 hours was independently associated with an increased risk of cranial nerve injury (hazard ratio 1.56, p < 0.0001). Conclusions. The risk of motor cranial nerve injury persisting beyond hospital discharge after CEA is approximately 4%. The vast majority of neurological deficits resolve over the next few months, however, and permanent deficits are rare. Nevertheless, the risk of cranial nerve injury should be communicated to patients before they undergo surgery.

scholarly journals Cranial Nerve Injuries and the Retrojugular Approach in Carotid Endarterectomy

2008 ◽  
Vol 90 (8) ◽  
pp. 685-688 ◽  
Author(s):  
William D Beasley ◽  
Christopher P Gibbons
Keyword(s):  
Carotid Endarterectomy ◽  
Cranial Nerve ◽  
Statistical Significance ◽  
Cranial Nerves ◽  
Case Series ◽  
Surgical Approaches ◽  
Nerve Injuries ◽  
Retrospective Case ◽  
Significant Difference ◽  
Cranial Nerve Injuries

INTRODUCTION This is a retrospective case series analysis to compare the incidence of cranial nerve injuries in carotid endarterectomy by the retrojugular and anteromedial approaches. PATIENTS AND METHODS Data were extracted from a prospectively collected database. Ninety-one retrojugular carotid endarterectomies were compared with 145 anteromedial carotid endarterectomies. All were performed under local anaesthesia and used the eversion technique. Data were analysed using the chi-squared test. RESULTS Nine (3.8%) cases were complicated by cranial nerve injuries. In four cases, multiple nerves were involved. In total, 13 (5.5%) cranial nerves were injured. The affected nerves were: two (0.8%) marginal mandibular, two (0.8%) laryngeal, three (1.2%) accessory and six (2.5%) hypoglossal. There was no statistically significant difference in total or specific cranial nerve injuries between the two surgical approaches. CONCLUSIONS The risk of cranial nerve injuries was similar following either the retrojugular or anteromedial approach. Accessory nerve injuries were only seen in the retrojugular approach but this did not reach statistical significance.

Cranial nerve injuries following carotid endarterectomy: An analysis of 336 procedures

Head & Neck ◽  
1991 ◽  
Vol 13 (2) ◽  
pp. 121-124 ◽  
Author(s):  
Anthony J. Maniglia ◽  
D. Peter Han
Keyword(s):  
Carotid Endarterectomy ◽  
Cranial Nerve ◽  
Nerve Injuries ◽  
Cranial Nerve Injuries

Literature Review of Cranial Nerve Injuries During Carotid Endarterectomy

2007 ◽  
Vol 107 (1) ◽  
pp. 25-28 ◽  
Author(s):  
M.S. Sajid ◽  
B. Vijaynagar ◽  
P. Singh ◽  
G. Hamilton
Keyword(s):  
Literature Review ◽  
Carotid Endarterectomy ◽  
Cranial Nerve ◽  
Nerve Injuries ◽  
Cranial Nerve Injuries

scholarly journals Prevention of Cranial Nerve Injuries during Carotid Endarterectomy

1997 ◽  
Vol 6 (9) ◽  
pp. 598-603
Author(s):  
Yoshinori Akiyama ◽  
Nobuo Hashimoto ◽  
Tetsuya Tsukahara ◽  
Toru Iwama ◽  
Shogo Nishi ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Cranial Nerve ◽  
Nerve Injuries ◽  
Cranial Nerve Injuries

Carotid Endarterectomy and Cranial Nerve Injuries

2006 ◽  
pp. 259-266
Author(s):  
Christos D. Liapis ◽  
John D. Kakisis
Keyword(s):  
Carotid Endarterectomy ◽  
Cranial Nerve ◽  
Nerve Injuries ◽  
Cranial Nerve Injuries

Cranial nerve injuries during carotid endarterectomy

1987 ◽  
Vol 154 (5) ◽  
pp. 529-532 ◽  
Author(s):  
Frederick W. Knight ◽  
Rod M. Yeager ◽  
Don M. Morris
Keyword(s):  
Carotid Endarterectomy ◽  
Cranial Nerve ◽  
Nerve Injuries ◽  
Cranial Nerve Injuries

scholarly journals The Carotid Endarterectomy Cadaveric Investigation for Cranial Nerve Injuries: Anatomical Study

2021 ◽  
Vol 11 (2) ◽  
pp. 211
Author(s):  
Orhun Mete Cevik ◽  
Murat Imre Usseli ◽  
Mert Babur ◽  
Cansu Unal ◽  
Murat Sakir Eksi ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Cranial Nerve ◽  
Injury Risk ◽  
Hypoglossal Nerve ◽  
Anatomical Study ◽  
Anatomical Variations ◽  
Cerebral Stroke ◽  
Nerve Injuries ◽  
Asymptomatic Patients ◽  
Cranial Nerve Injuries

Cerebral stroke continues to be one of the leading causes of mortality and long-term morbidity; therefore, carotid endarterectomy (CEA) remains to be a popular treatment for both symptomatic and asymptomatic patients with carotid stenosis. Cranial nerve injuries remain one of the major contributor to the postoperative morbidities. Anatomical dissections were carried out on 44 sides of 22 cadaveric heads following the classical CEA procedure to investigate the variations of the local anatomy as a contributing factor to cranial nerve injuries. Concurrence of two variations was found to be important in hypoglossal nerve injury: the presence of a direct smaller vein in proximity of the carotid bifurcation, and the intersection of the hypoglossal nerve (HN) with this vein. Based on the sample investigated, this variation was observed significantly higher on the right side. Awareness of possible anatomical variations and early ligation of any small veins can significantly decrease iatrogenic injury risk.

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