eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Head & Neck Surgery

Management of the Neck With Carotid Artery Involvement: Follow-up

Author: Devraj Basu, MD, PhD, FACS, Assistant Professor, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System
Coauthor(s): John M Truelson, MD, FACS, Chairman, Division of Head and Neck Surgery, Associate Professor, Department of Otorhinolaryngology, University of Texas Southwestern Medical Center at Dallas; Gregory S Weinstein, MD, FACS, Professor and Vice-Chairman, Department of Otorhinolaryngology-Head and Neck Surgery, Director of Division of Head and Neck Surgery, Director of Head and Oncology Fellowship, Director of Otorhinolaryngology-Head and Neck Clinic, Co-director of The Center for Head and Neck Surgery, University of Pennsylvania School of Medicine
Contributor Information and Disclosures

Updated: Mar 5, 2009

Outcome and Prognosis

Long-term survival is generally poor in cases of malignant carotid involvement; early local recurrence is the norm, and rapid failure with distant metastatic disease is also common. Yet, no universal case against carotid resection can be made, and each patient merits careful consideration within his or her broad clinical context. In fact, recent data show significant numbers of long-term survivors among previously untreated patients undergoing carotid resection.6 These favorable surgical outcomes for very advanced tumors suggest that carotid resection does still have a limited role in the management of the head and neck cancer. Patients require extensive preoperative counseling and must contemplate surgery bearing in mind substantial risks, including those of devastating neurologic sequelae. This risk can be managed significantly by carotid reconstruction whenever possible, but adverse neurologic outcomes from carotid resection cannot be prevented altogether.

 


More on Management of the Neck With Carotid Artery Involvement

Overview: Management of the Neck With Carotid Artery Involvement
Workup: Management of the Neck With Carotid Artery Involvement
Treatment: Management of the Neck With Carotid Artery Involvement
Follow-up: Management of the Neck With Carotid Artery Involvement
References
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References

  1. Wright JG, Nicholson R, Schuller DE, Smead WL. Resection of the internal carotid artery and replacement with greater saphenous vein: a safe procedure for en bloc cancer resections with carotid involvement. J Vasc Surg. May 1996;23(5):775-80; discussion 781-2. [Medline].

  2. Freeman SB, Hamaker RC, Borrowdale RB, Huntley TC. Management of neck metastasis with carotid artery involvement. Laryngoscope. Jan 2004;114(1):20-4. [Medline].

  3. Huvos AG, Leaming RH, Moore OS. Clinicopathologic study of the resected carotid artery. Analysis of sixty-four cases. Am J Surg. Oct 1973;126(4):570-4. [Medline].

  4. McCready RA, Miller SK, Hamaker RC, Singer MI, Herod GT. What is the role of carotid arterial resection in the management of advanced cervical cancer?. J Vasc Surg. Sep 1989;10(3):274-80. [Medline].

  5. Sanna M, Piazza P, Ditrapani G, Agarwal M. Management of the internal carotid artery in tumors of the lateral skull base: preoperative permanent balloon occlusion without reconstruction. Otol Neurotol. Nov 2004;25(6):998-1005. [Medline].

  6. Ozer E, Agrawal A, Ozer HG, Schuller DE. The impact of surgery in the management of the head and neck carcinoma involving the carotid artery. Laryngoscope. Oct 2008;118(10):1771-4. [Medline].

  7. Roh JL, Kim MR, Choi SH, et al. Can patients with head and neck cancers invading carotid artery gain survival benefit from surgery?. Acta Otolaryngol. 2008;128(12):1370-4. [Medline].

  8. Yoo GH, Hocwald E, Korkmaz H, et al. Assessment of carotid artery invasion in patients with head and neck cancer. Laryngoscope. Mar 2000;110(3 Pt 1):386-90. [Medline].

  9. Yousem DM, Hatabu H, Hurst RW, et al. Carotid artery invasion by head and neck masses: prediction with MR imaging. Radiology. Jun 1995;195(3):715-20. [Medline].

  10. Konno A, Togawa K, Iizuka K. Analysis of factors affecting complications of carotid ligation. Ann Otol Rhinol Laryngol. May-Jun 1981;90(3 Pt 1):222-6. [Medline].

  11. Maves MD, Bruns MD, Keenan MJ. Carotid artery resection for head and neck cancer. Ann Otol Rhinol Laryngol. Sep 1992;101(9):778-81. [Medline].

  12. Razack MS, Sako K. Carotid artery hemorrhage and ligation in head and neck cancer. J Surg Oncol. Apr 1982;19(4):189-92. [Medline].

  13. Jones TH, Morawetz RB, Crowell RM, et al. Thresholds of focal cerebral ischemia in awake monkeys. J Neurosurg. Jun 1981;54(6):773-82. [Medline].

  14. Ehrnefeld WK, Stoney RJ, Wylie EJ. Relation of carotid stump pressure to safety of carotid artery ligation. Surgery. Feb 1983;93(2):299-305. [Medline].

  15. Kelly JJ, Callow AD, O'Donnell TF, et al. Failure of carotid stump pressures. Its incidence as a predictor for a temporary shunt during carotid endarterectomy. Arch Surg. Dec 1979;114(12):1361-6. [Medline].

  16. James NJ, Stuteville OH, Tasche C. Elective carotid artery ligation in the treatment of advanced cancer of the head and neck. Plast Reconstr Surg. Mar 1971;47(3):243-5. [Medline].

  17. Standard SC, Ahuja A, Guterman LR, et al. Balloon test occlusion of the internal carotid artery with hypotensive challenge. AJNR Am J Neuroradiol. Aug 1995;16(7):1453-8. [Medline].

  18. Andersen AR, Friberg HH, Schmidt JF, Hasselbalch SG. Quantitative measurements of cerebral blood flow using SPECT and [99mTc]-d,l-HM-PAO compared to xenon-133. J Cereb Blood Flow Metab. Dec 1988;8(6):S69-81. [Medline].

  19. Erba SM, Horton JA, Latchaw RE, et al. Balloon test occlusion of the internal carotid artery with stable xenon/CT cerebral blood flow imaging. AJNR Am J Neuroradiol. May-Jun 1988;9(3):533-8. [Medline].

  20. Witt JP, Yonas H, Jungreis C. Cerebral blood flow response pattern during balloon test occlusion of the internal carotid artery. AJNR Am J Neuroradiol. May 1994;15(5):847-56. [Medline].

  21. Adams GL, Madison M, Remley K, Gapany M. Preoperative permanent balloon occlusion of internal carotid artery in patients with advanced head and neck squamous cell carcinoma. Laryngoscope. Mar 1999;109(3):460-6. [Medline].

  22. Eckard DA, Purdy PD, Bonte FJ. Temporary balloon occlusion of the carotid artery combined with brain blood flow imaging as a test to predict tolerance prior to permanent carotid sacrifice. AJNR Am J Neuroradiol. Nov-Dec 1992;13(6):1565-9. [Medline].

  23. Gonzalez CF, Moret J. Balloon occlusion of the carotid artery prior to surgery for neck tumors. AJNR Am J Neuroradiol. Jul-Aug 1990;11(4):649-52. [Medline].

  24. Meleca RJ, Marks SC. Carotid artery resection for cancer of the head and neck. Arch Otolaryngol Head Neck Surg. Sep 1994;120(9):974-8. [Medline].

  25. de Vries EJ, Sekhar LN, Horton JA, et al. A new method to predict safe resection of the internal carotid artery. Laryngoscope. Jan 1990;100(1):85-8. [Medline].

  26. Segal DH, Sen C, Bederson JB, Catalano P, Sacher M, Stollman AL. Predictive value of balloon test occlusion of the internal carotid artery. Skull Base Surg. 1995;5(2):97-107. [Medline].

  27. Nishioka H. Results of the treatment of intracranial aneurysms by occlusion of the carotid artery in the neck. J Neurosurg. Dec 1966;25(6):660-704. [Medline].

  28. Youmans JR, Kindt GW, Mitchell OC. Extended studies of direction of flow and pressure in the internal carotid artery following common carotid artery ligation. J Neurosurg. Sep 1967;27(3):250-4. [Medline].

  29. Barnett HJ. Delayed cerebral ischemic episodes distal to occlusion of major cerebral arteries. Neurology. Aug 1978;28(8):769-74. [Medline].

  30. Berenstein A, Ransohoff J, Kupersmith M, Flamm E, Graeb D. Transvascular treatment of giant aneurysms of the cavernous carotid and vertebral arteries. Functional investigation and embolization. Surg Neurol. Jan 1984;21(1):3-12. [Medline].

  31. Freeman SB, Hamaker RC, Borrowdale RB, Huntley TC. Management of neck metastasis with carotid artery involvement. Laryngoscope. Jan 2004;114(1):20-4. [Medline].

  32. German WJ, Black SP. Cervical ligation for internal carotid aneurysms. An extended follow-up. J Neurosurg. Dec 1965;23(6):572-7. [Medline].

  33. Wright JG, Nicholson R, Schuller DE, Smead WL. Resection of the internal carotid artery and replacement with greater saphenous vein: a safe procedure for en bloc cancer resections with carotid involvement. J Vasc Surg. May 1996;23(5):775-80; discussion 781-2. [Medline].

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Further Reading

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Keywords

management of the neck with carotid artery involvement, carotid artery, carotid involvement, malignant carotid invasion, malignant carotid involvement, carotid reconstruction, carotid artery reconstruction, carotid weakness, arterial wall weakness, arterial wall rupture, carotid artery rupture, carotid rupture, herald bleed, carotid ligation, sudden carotid rupture, carotid occlusion, CVA, cardiovascular accident, TBO, total balloon occlusion, xenon, Xe, carotid resection

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Contributor Information and Disclosures

Author

Devraj Basu, MD, PhD, FACS, Assistant Professor, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System
Devraj Basu, MD, PhD, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Association for Cancer Research, American College of Surgeons, and American Head and Neck Society
Disclosure: Nothing to disclose.

Coauthor(s)

John M Truelson, MD, FACS, Chairman, Division of Head and Neck Surgery, Associate Professor, Department of Otorhinolaryngology, University of Texas Southwestern Medical Center at Dallas
John M Truelson, MD, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, Phi Beta Kappa, and Texas Medical Association
Disclosure: Nothing to disclose.

Gregory S Weinstein, MD, FACS, Professor and Vice-Chairman, Department of Otorhinolaryngology-Head and Neck Surgery, Director of Division of Head and Neck Surgery, Director of Head and Oncology Fellowship, Director of Otorhinolaryngology-Head and Neck Clinic, Co-director of The Center for Head and Neck Surgery, University of Pennsylvania School of Medicine
Gregory S Weinstein, MD, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Laryngological Association, American Laryngological Rhinological and Otological Society, American Medical Association, American Radium Society, American Society for Head and Neck Surgery, Pennsylvania Medical Society, Philadelphia County Medical Society, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Richard V Smith, MD, Director of Clinical Affairs, Associate Professor, Department of Otolaryngology, Division of Head and Neck Surgery, Einstein College of Medicine, Montefiore Medical Center
Richard V Smith, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Laryngological Rhinological and Otological Society, American Medical Association, American Medical Student Association/Foundation, Medical Society of the District of Columbia, New York Academy of Medicine, and Vermont State Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Nader Sadeghi, MD, FRCS(C), Associate Professor of Surgery, Director of Head and Neck Surgery, Division of Otolaryngology, George Washington University
Nader Sadeghi, MD, FRCS(C) is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, Federation of Medical Specialists in Quebec, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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