Incidence of cranial nerve injuries after carotid eversion endarterectomy with a transverse skin incision under regional anaesthesia.
OBJECTIVE
The objective of this prospective study was to evaluate the incidence and distribution of cranial nerve injuries after carotid eversion endarterectomy (EEA) performed under regional anaesthesia using a transverse skin incision.


METHODS
The study included 165 patients and 180 carotid arteries. All patients had a standard pre-operative assessment performed by a neurologist and ENT specialist. All carotid endarterectomies were performed by the eversion technique under regional anaesthesia.


RESULTS
Ten cranial nerve injuries were observed. Seven patients had injuries of the marginal mandibular branch of the facial nerve, two patients had lesions of the hypoglossal nerve, and one patient had an injury of the recurrent laryngeal nerve. Eleven patients developed hoarseness without cranial nerve injury. Injuries of the marginal mandibular branch recovered after 3-8 months (mean 5.2 months). Both hypoglossal nerve injuries recovered after 4 months. The patient with the recurrent laryngeal palsy had no improvement after 19 months. Patients with hoarseness secondary to laryngeal haematoma recovered within 1 month.


CONCLUSIONS
The incidence of cranial nerves injury after carotid EEA under regional anaesthesia is comparable to that reported for conventional carotid surgery. Postoperative hoarseness is most frequently due to laryngeal haematoma.
Assadian
A
A
Department of General and Vascular Surgery, Wilhelminenspital Vienna, Austria. afshin_assadian@yahoo.de
Senekowitsch
C
C
Pfaffelmeyer
N
N
Assadian
O
O
Ptakovsky
H
H
Hagmüller
G W
GW
D000368:Aged; D000369:Aged, 80 and over; D000765:Anesthesia, Conduction; D002343:Carotid Artery, Internal / Q000601:surgery; D016893:Carotid Stenosis / Q000453:epidemiology / Q000601:surgery; D020209:Cranial Nerve Injuries / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D062109:Dermatologic Surgical Procedures; D016894:Endarterectomy, Carotid; D020220:Facial Nerve Injuries / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D006801:Humans; D007002:Hypoglossal Nerve / Q000000981:diagnostic imaging / Q000601:surgery; D061228:Hypoglossal Nerve Injuries; D015994:Incidence; D061224:Laryngeal Nerve Injuries; D007823:Laryngeal Nerves / Q000000981:diagnostic imaging / Q000601:surgery; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D010243:Paralysis / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D012867:Skin / Q000000981:diagnostic imaging / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome