Results of surgery for head and neck tumors that involve the carotid artery at the skull base

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Abstract
To evaluate the results of surgery in patients with head and neck cancers that involved the internal carotid artery at the skull base the authors retrospectively reviewed a consecutive series of 17 patients who underwent surgery at Mount Sinai Hospital over a 4-year period. In general, patients who underwent tumor resection with carotid preservation had less advanced disease (two of seven tumors were recurrences) than patients who underwent tumor resection with carotid sacrifice (seven of 10 tumors were recurrences). Of seven patients who underwent resection with carotid preservation, six had good outcomes (five patients alive in good condition, one dead at 2.2 years) and none had strokes. Of seven patients who underwent resection with carotid sacrifice and bypass, five had good outcomes (four alive in good condition, one dead at 2.5 years with no local recurrence) and two suffered graft occlusions that led to strokes, one of which was major and permanently disabling. Of three patients who underwent resection with carotid sacrifice and ligation without revascularization, there were no good outcomes: all three patients died within 6 months of surgery, two having suffered major permanently disabling strokes. The overall results (11 [65%] of 17 with good outcomes at an average follow-up period of 2.1 years) compared very favorably with historical nonsurgical controls. The authors conclude that tumor resection with carotid preservation carries the lowest risk of stroke and should usually be the treatment of choice. For patients with more advanced and recurrent disease, in whom it is believed that carotid preservation would prevent a safe and oncologically meaningful resection, carotid sacrifice with carotid bypass may be a useful treatment option. Carotid sacrifice without revascularization seems to be the treatment option with the least favorable results.