Cranial and cervical nerve injuries after carotid endarterectomy: a prospective study.
BACKGROUND
The purpose of this study was to review the outcome of patients who had cranial and cervical nerve injuries after carotid endarterectomy (CEA).


METHODS
This prospective study reviewed 200 consecutive CEAs. Preoperative and postoperative cranial nerve assessment was completed on all patients. Neurologic evaluation included routine direct fiberoptic laryngoscopy. Patients found to have no neurologic injury had no further follow-up. Patients with postoperative peripheral neurologic dysfunction were enrolled for regular long-term follow-up to assess delayed recovery.


RESULTS
Overall, 25 (12.5%) nerve injuries were identified in 24 patients. There were 11 (5.5%) hypoglossal, 8 (4%) recurrent laryngeal, 2 (1%) superior laryngeal, 2 (1%) marginal mandibular, and 2 (1%) greater auricular nerve injuries. None of the patients were lost to follow-up. All nerve dysfunctions were transient, with all but 4 nerves recovering completely within 6 months. The recovery took from 1 week to 37 months, with a mean recovery time of 5.8 months. Two patients with recurrent laryngeal nerve dysfunction were found to have prolonged full recovery time (i.e., 31 and 37 months, respectively). Two patients successfully underwent contralateral CEA, although movement of the opposite vocal cord was not fully restored.


CONCLUSIONS
Cranial nerve injury after CEA is a common occurrence and can be classified as a "major" or "minor" complication, depending on the severity of the clinical consequences. Extended follow-up will identify the specific subset of patients with a late complete nerve recovery.
Ballotta
E
E
First Institute of General Surgery, University of Padua, School of Medicine, Italy.
Da Giau
G
G
Renon
L
L
Narne
S
S
Saladini
M
M
Abbruzzese
E
E
Meneghetti
G
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D020209:Cranial Nerve Injuries; D003391:Cranial Nerves / Q000503:physiopathology; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality; D006801:Humans; D007002:Hypoglossal Nerve / Q000503:physiopathology; D061228:Hypoglossal Nerve Injuries; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000601:surgery; D061224:Laryngeal Nerve Injuries; D007823:Laryngeal Nerves / Q000503:physiopathology; D008297:Male; D008340:Mandibular Nerve / Q000503:physiopathology; D008875:Middle Aged; D011446:Prospective Studies; D012009:Recurrent Laryngeal Nerve / Q000503:physiopathology; D061226:Recurrent Laryngeal Nerve Injuries; D012189:Retrospective Studies; D061221:Trigeminal Nerve Injuries; D000159:Vestibulocochlear Nerve / Q000503:physiopathology; D061285:Vestibulocochlear Nerve Injuries