Management of the internal carotid artery in tumors of the lateral skull base: preoperative permanent balloon occlusion without reconstruction.
OBJECTIVE
To present our experience with permanent preoperative balloon occlusion of the internal carotid artery while dealing with different abnormalities of the lateral skull base and a comparison with the results mentioned in the literature.


METHODS
Retrospective case review.


METHODS
Private neurotologic and skull base tertiary referral center.


METHODS
Fifteen patients who underwent preoperative balloon occlusion of the internal carotid artery and surgery subsequently for various abnormalities of the lateral skull base between 1989 and 2002.


METHODS
Each patient was subjected to four-vessel angiography along with the manual cross-compression test and balloon test occlusion to assess the efficacy of the collateral circulation. After angiography, each patient underwent a preoperative balloon occlusion, after which a lateral skull base procedure was performed for removal of the abnormality.


METHODS
Only those patients showing evidence of adequate collateral cerebral circulation and a less than 1-second delay between the angiographic phases of the two cerebral hemispheres on angiography were considered fit for preoperative balloon occlusion. While under going the preoperative balloon occlusion, the patients were clinically assessed for the development of any neurologic symptoms and signs. Long-term follow-up after surgery was also based on the development of symptoms and signs of neurovascular compromise.


RESULTS
A major complication in the form of long-lasting hemiplegia occurred in one patient (6.7%). This complication was the result of technical factors rather than an effect of cerebral ischemia, because it was caused by an intimal dissection produced by the catheter. A defect in the visual field occurred in one patient (6.7%) that resolved partially after antiplatelet therapy. There was no mortality in our series related to preoperative balloon occlusion of the internal carotid artery.


CONCLUSIONS
Preoperative balloon occlusion of the internal carotid artery can still be considered a viable option for the management of the internal carotid artery during lateral skull base surgery. Proper preoperative evaluation of the adequacy and efficacy of the collateral cerebral circulation reduces the chances of postoperative neurovascular complications.
Sanna
Mario
M
Gruppo Otologico, Piacenza-Rome, University of Parma, Parma, Italy. mario.sanna@gruppootologico.it
Piazza
Paolo
P
Ditrapani
Giuseppe
G
Agarwal
Manoj
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D021721:Balloon Occlusion / Q000379:methods*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000502:physiology; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation / Q000502:physiology; D003097:Collateral Circulation / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies; D019291:Skull Base / Q000473:pathology / Q000601:surgery; D019292:Skull Base Neoplasms / Q000601:surgery / Q000628:therapy*