Risk of persistent cranial nerve injury after carotid endarterectomy

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.

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A Prospective Study on the Incidence and Outcome of Cranial Nerve Injuries in Patients with Traumatic Brain Injuries

Indian Journal of Neurotrauma ◽

10.1055/s-0041-1724141 ◽

2021 ◽

Author(s):

Noufal Basheer ◽

Jenimol Chacko Varghese ◽

Noufal Basheer ◽

Rojan Kuruvilla ◽

Jacob P. Alappat ◽

...

Keyword(s):

Cranial Nerve ◽

Brain Injuries ◽

Traumatic Brain Injuries ◽

Age Group ◽

Nerve Injuries ◽

Younger Age ◽

Cranial Nerve Injury ◽

Cranial Nerve Injuries ◽

A Prospective Study

Abstract Background Posttraumatic cranial nerve injuries are not uncommon and can occur by shearing forces, rapid acceleration/deceleration, or injury to the skull base. The incidence of cranial nerve injury in craniocerebral trauma varies between 5 and 23 percent in various literature. Methodology A prospective study was conducted on the incidence and outcome of cranial nerve injuries (CNI) in 256 consecutive cases of traumatic brain injuries (TBI). Patients over the age of 5 years with a follow-up of 6 months in the period from September 2017 to November 2018 in our institution were sampled. Results A total of 256 patients were included in our study. The incidence of CNI in TBI patients was 14.8% (38 patients). Facial nerve was the most common cranial nerve to be involved, followed by olfactory nerve and vestibulocochlear nerve. Cranial nerve injury was more common in patients with severe head injury (p < 0.005), younger age group, associated base of skull fractures (p < 0.001), and facial fractures (p < 0.005). Twenty-eight patients (73.7%) had a delayed presentation of CNI (p < 0.001). Of the 73.6% patients who recovered, 16 (42%) patients had partial recovery, while 12 (31%) patients had complete recovery. Younger age group (p < 0.05) and delayed onset of deficit (p < 0.001) were associated with significant better outcome. Conclusions CNI are a major cause of morbidity in TBI patients. All patients admitted with TBI should be examined meticulously for CNI on follow-up.

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Cranial nerve injuries in adult faciomaxillary trauma: prospective study in a tertiary referral centre

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20193867 ◽

2019 ◽

Vol 5 (5) ◽

pp. 1264

Author(s):

Gowrishankar Murari ◽

Kannathal Duraipandi ◽

Sankara Subramanian Muthusamy

Keyword(s):

Prospective Study ◽

Nerve Injury ◽

Cranial Nerve ◽

Maxillofacial Trauma ◽

Motor Deficit ◽

Care Hospital ◽

Nerve Injuries ◽

Early Management ◽

Cranial Nerve Injury ◽

Cranial Nerve Injuries

Background: Cranial nerve injury is often an overlooked aspect of faciomaxillary trauma. Most of these injuries do require active intervention in the acute stage. Cranial nerve injuries require long-term management, repeated surgical procedures or reconstructive measures.Methods: The study was conducted for one-year prospective study of clinical evaluation of 180 patients with faciomaxillary injuries from May 2017 to May 2018 at tertiary care hospital. There were 154 male patients (86.3%) and 26 (13.7%) female patients. The patients from the age of 18 onwards were included in the study group after obtaining consent. A number of parameters, including age, gender, injury of cranial nerve injuries, sensory and motor deficit in relation to soft tissue trauma and bone fracture were evaluated. The objective of the present study is to evaluate early management and document the frequency of cranial nerve injuries associated with maxillofacial trauma.Results: In 180 cases of faciomaxillary trauma, 60 patients presented with cranial nerve injuries including olfactory, optic, trigeminal, facial, vestibulocochlear, abducens nerve either as an isolated or combined cranial nerve injuries. Out of which most common nerve to get injured was trigeminal followed by facial nerve observed in our study.Conclusions: Cranial nerve injury in maxillofacial trauma is significant and it should be addressed at the time of treatment so that quality of life of patient is improved by getting back his sensory and motor functions of the injured nerves.

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Stereotactic radiotherapy for the treatment of acoustic neuromas

Journal of Neurosurgery ◽

10.3171/sup.2004.101.supplement3.0362 ◽

2004 ◽

Vol 101 (Supplement3) ◽

pp. 362-372 ◽

Cited By ~ 38

Author(s):

Michael T. Selch ◽

Alessandro Pedroso ◽

Steve P. Lee ◽

Timothy D. Solberg ◽

Nzhde Agazaryan ◽

...

Keyword(s):

Stereotactic Radiotherapy ◽

Tumor Size ◽

Cranial Nerve ◽

Target Volume ◽

Tumor Control ◽

Content Type ◽

Seventh Cranial Nerve ◽

Acoustic Neuromas ◽

Fine Print

Object. The authors sought to assess the safety and efficacy of stereotactic radiotherapy when using a linear accelerator equipped with a micromultileaf collimator for the treatment of patients with acoustic neuromas. Methods. Fifty patients harboring acoustic neuromas were treated with stereotactic radiotherapy between September 1997 and June 2003. Two patients were lost to follow-up review. Patient age ranged from 20 to 76 years (median 59 years), and none had neurofibromatosis. Forty-two patients had useful hearing prior to stereotactic radiotherapy. The fifth and seventh cranial nerve functions were normal in 44 and 46 patients, respectively. Tumor volume ranged from 0.3 to 19.25 ml (median 2.51 ml). The largest tumor dimension varied from 0.6 to 4 cm (median 2.2 cm). Treatment planning in all patients included computerized tomography and magnetic resonance image fusion and beam shaping by using a micromultileaf collimator. The planning target volume included the contrast-enhancing tumor mass and a margin of normal tissue varying from 1 to 3 mm (median 2 mm). All tumors were treated with 6-MV photons and received 54 Gy prescribed at the 90% isodose line encompassing the planning target volume. A sustained increase greater than 2 mm in any tumor dimension was defined as local relapse. The follow-up duration varied from 6 to 74 months (median 36 months). The local tumor control rate in the 48 patients available for follow up was 100%. Central tumor hypodensity occurred in 32 patients (67%) at a median of 6 months following stereotactic radiotherapy. In 12 patients (25%), tumor size increased 1 to 2 mm at a median of 6 months following stereotactic radiotherapy. Increased tumor size in six of these patients was transient. In 13 patients (27%), tumor size decreased 1 to 14 mm at a median of 6 months after treatment. Useful hearing was preserved in 39 patients (93%). New facial numbness occurred in one patient (2.2%) with normal fifth cranial nerve function prior to stereotactic radiotherapy. New facial palsy occurred in one patient (2.1%) with normal seventh cranial nerve function prior to treatment. No patient's pretreatment dysfunction of the fifth or seventh cranial nerve worsened after stereotactic radiotherapy. Tinnitus improved in six patients and worsened in two. Conclusions. Stereotactic radiotherapy using field shaping for the treatment of acoustic neuromas achieves high rates of tumor control and preservation of useful hearing. The technique produces low rates of damage to the fifth and seventh cranial nerves. Long-term follow-up studies are necessary to confirm these findings.

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Risk of late stroke and survival following carotid endarterectomy procedures for symptomatic patients

Journal of Neurosurgery ◽

10.3171/jns.1990.73.2.0193 ◽

1990 ◽

Vol 73 (2) ◽

pp. 193-200 ◽

Cited By ~ 5

Author(s):

Dennis A. Turner ◽

Jay Tracy ◽

Stephen J. Haines

Keyword(s):

Carotid Endarterectomy ◽

Life Table ◽

Stroke Risk ◽

Neurological Symptoms ◽

Treatment Modalities ◽

Control Group ◽

Content Type ◽

Postoperative Stroke ◽

Fine Print

✓ The long-term outcome following carotid endarterectomy for neurological symptoms was analyzed using a retrospective life-table approach in 212 patients who had undergone 243 endarterectomy procedures. The postoperative follow-up period averaged 38.9 ± 2.1 months (mean ± standard error of the mean). The endpoints of stroke and death were evaluated in these patients. Patient groups with the preoperative symptoms of amaurosis fugax, transient ischemic attack, and prior recovered stroke were similar in terms of life-table outcome over the follow-up period. Sixty-two percent of symptomatic patients were alive and free of stroke at 5 years. The late risk of stroke (after 30 days postoperatively) averaged 1.7% per year based on a linear approximation to the hazard at each life-table interval (1.3% per year for ipsilateral stroke). The trend of late stroke risk was clearly downward, however, and could be fitted more accurately by an exponential decay function with a half-life of 33 months. Thus, the risk of stroke following carotid endarterectomy for neurological symptoms was highest in the perioperative period, slowly declined with time, and occurred predominantly ipsilateral to the procedure. The definition of a prospective medical control group remains crucial for a critical analysis of treatment modalities following the onset of premonitory neurological symptoms. In the absence of an adequate control group for this series, the calculated perioperative and postoperative stroke risk from this study was compared to data obtained from the literature on stroke risk in medically treated symptomatic patients. This uncontrolled comparison of treatment modalities suggests the combined perioperative and postoperative stroke risk associated with carotid endarterectomy to be modestly improved over medical treatment alone.

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Cranial nerve injury is associated with dual antiplatelet therapy use and cervical hematoma after carotid endarterectomy

Journal of Vascular Surgery ◽

10.1016/j.jvs.2016.04.029 ◽

2016 ◽

Vol 64 (4) ◽

pp. 985-989.e2 ◽

Cited By ~ 7

Author(s):

Emiliano Chisci ◽

Thomas F. Rehring ◽

Clara Pigozzi ◽

Serena Colon ◽

Alessandra Borgheresi ◽

...

Keyword(s):

Carotid Endarterectomy ◽

Antiplatelet Therapy ◽

Nerve Injury ◽

Cranial Nerve ◽

Dual Antiplatelet Therapy ◽

Cervical Hematoma ◽

Cranial Nerve Injury

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Carotid Endarterectomy and Cranial Nerve Injuries

Vascular Surgery ◽

10.1007/978-1-4471-3870-9_32 ◽

2003 ◽

pp. 245-252

Author(s):

C. D. Liapis ◽

J. D. Kakisis

Keyword(s):

Carotid Endarterectomy ◽

Cranial Nerve ◽

Nerve Injuries ◽

Cranial Nerve Injuries

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Traumatic dislocation of the atlanto-occipital articulation (AOA) with short-term survival

Journal of Neurosurgery ◽

10.3171/jns.1980.52.4.0541 ◽

1980 ◽

Vol 52 (4) ◽

pp. 541-546 ◽

Cited By ~ 74

Author(s):

Arthur B. Dublin ◽

William M. Marks ◽

David Weinstock ◽

Thomas H. Newton

Keyword(s):

Systemic Hypertension ◽

Nerve Injuries ◽

Short Term ◽

Term Survival ◽

Content Type ◽

Traumatic Dislocation ◽

Cranial Nerve Injuries ◽

Angiographic Evidence ◽

Fine Print ◽

Short Term Survival

✓ Three patients with traumatic atlanto-occipital articulation (AOA) dislocation are presented, and an additional 10 well documented cases are reviewed from the literature. Medulla oblongata and/or spinal cord deficits, and evidence of cranial nerve injuries were noted in eight patients. Angiographic evidence of vertebral occlusion or narrowing was demonstrated in four patients. One patient had systemic hypertension, presumably from bilateral traumatic ninth nerve injuries. Five patients ultimately died. A new method for measuring the AOA is introduced.

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