Salvage of advanced squamous cell carcinomas of the head and neck: internal carotid artery sacrifice and extracranial-intracranial revascularization.
OBJECTIVE
Squamous cell carcinoma (SCC) of the head and neck may involve the carotid artery (CA) in the neck or skull base. Whether tumor resection should be associated with sacrifice of the CA is debatable.


METHODS
Records obtained in five consecutive patients (three men, and two women; mean age 58 years, range 47-69 years) treated for recurrent or progressive SCC involving the internal carotid artery (ICA) at the skull base were reviewed retrospectively. The ICA was sacrificed, an extracranial-intracranial (EC-IC) bypass was performed using a saphenous vein graft, and the tumor and involved ICA segment were resected. Gross-total resection of the SCC was achieved in four cases. One patient died of an acute postoperative stroke due to bypass occlusion and did not undergo tumor resection. No other permanent ischemic or neurological deficits were noted. The other four patients died of tumor progression (survival range 2-40 months, mean 14 months). One patient survived for more than 2 years (2-year overall survival rate 20%). Histological tumor invasion of the CA wall was verified in one of the three evaluated specimens.


CONCLUSIONS
A high rate of morbidity and mortality is associated with cases in which skull base CA sacrifice and an EC-IC bypass are performed. Not all resected arteries are shown to have malignant infiltration on histological examination. Better preoperative imaging criteria are needed to define malignant infiltration of the ICA at the skull base. Chemotherapy and radiotherapy without aggressive tumor resection may be an option for these patients.
Feiz-Erfan
Iman
I
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Han
Patrick P
PP
Spetzler
Robert F
RF
Lanzino
Giuseppe
G
Ferreira
Mauro A T
MA
Gonzalez
L Fernando
LF
Porter
Randall W
RW
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000473:pathology / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods*; D018450:Disease Progression; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care; D016879:Salvage Therapy; D012501:Saphenous Vein / Q000637:transplantation; D019291:Skull Base; D020521:Stroke / Q000209:etiology; D014182:Transplantation, Autologous