Outcome of Extracranial Carotid Pseudoaneurysm Surgery: A  Retrospective Study

Introduction Extracranial carotid pseudoaneurysm (ECPA) is commonly associated with blunt or penetrating trauma and can result in thromboembolic event, cranial nerves palsies, rupture and hemorrhage. Due to the limited number of large studies, safety and efficacy of surgical and interventional management of ECPA is not well characterized. Open surgery with resection of pseudoaneurysm with end-to-end anastomosis or interposition graft is currently the preferred method of management. The aim of this study is to study the demographics, etiopathogenesis, presentation and outcome after surgical intervention of ECPA at our center. MethodsAll patients who underwent surgery for carotid pseudoaneurysm form June 2012 to December 2019, at Department of Cardiothoracic and Vascular Surgery were included in this retrospective chart review study after evaluation of the hospital record book and electronic medical record. Patients who had stroke or cranial nerve injury before surgery, were excluded from this study. ResultsFifteen patients met the inclusion criteria. Male to female ratio was 11:4. Mean age of presentation was 38.17±18.98 years. All patients presented with tender and pulsatile neck swelling. Common carotid artery involvement was more common. Three patients suffered from stroke postoperatively, and all of these patients died, however, one patient with stroke died due to reasons not related to pseudoaneurysm. Two patients suffered cranial nerve injury and ten patients had no other disabling complications. ConclusionECPA is an uncommon but a serious disease and ischemic stroke after surgery is associated with high mortality.

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Brain Stem and Cranial Nerve Monitoring

Clinical Neurophysiology ◽

10.1093/med/9780195385113.003.0043 ◽

2009 ◽

pp. 739-750

Author(s):

Brian A. Crum

Keyword(s):

Brain Stem ◽

Nerve Injury ◽

Cranial Nerve ◽

Cranial Nerves ◽

Posterior Fossa Surgery ◽

Surgical Team ◽

Nerve Monitoring ◽

Cranial Nerve Injury ◽

Clinical Detection ◽

Multimodality Approach

Various modalities are available for monitoring the function of the cranial nerves and brain stem during intracranial or extracranial head and neck operations. After consideration of the surgical risks, a multimodality approach can be tailored to the needs of each patient. Close communication between the IOM team and the surgical team is vital in order to obtain appropriate electrophysiological information and provide useful feedback at a time when clinical detection of nerve injury is impossible. IOM has been shown to decrease the incidence of cranial nerve injury during posterior fossa surgery.

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Trauma to the cranial nerves

Indian Journal of Neurotrauma ◽

10.1016/s0973-0508(07)80022-0 ◽

2007 ◽

Vol 04 (02) ◽

pp. 89-100 ◽

Cited By ~ 4

Author(s):

Harjinder S Bhatoe

Keyword(s):

Nerve Injury ◽

Cranial Nerve ◽

Cranial Nerves ◽

Acute Stage ◽

Appropriate Treatment ◽

Cranial Nerve Injury ◽

Cranial Nerve Injuries ◽

Ultimate Outcome ◽

Lower Cranial Nerves

AbstractCranial nerve injury is often an overlooked aspect of neurotrauma, which is diagnosed later in the course of recovery. Most of these injuries do not require active intervention in the acute stage. Cranial nerve injuries are important cause of morbidity, which requires long-term management, repeated surgical procedures or reconstructive measures. Management of optic nerve injury remains controversial, and injury to lower cranial nerves may influence the ultimate outcome due to paralysis of aerodigestive passage. Cranial nerve injury in the setting of head injury should be diagnosed early, so that appropriate treatment can be planned early.

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