Cranial Nerve Dysfunction Following Carotid Endarterectomy

Abstract

In an effort to establish the true incidence of cranial nerve dysfunction after carotid endarterectomy, 50 consecutive carotid endarterectomy procedures were assessed by careful and objective preoperative and postoperative cranial nerve evaluations, including indirect laryngoscopic examination by a trained ENT surgeon. Of the 50 patients evaluated, 2 (4%) were found to have a postoperative cranial nerve deficit, and these were the following: 1 (2%) recurrent laryngeal, none (0%) superior laryngeal, 1 (2%) marginal mandibular nerve, and none (0%) hypoglossal nerve. In no instance was any patient who was asymptomatic found to have unsuspected objective evidence of cranial nerve injury; on the other hand, both symptomatic patients were found to have a significant cranial nerve injury by further evaluation. Our objective data refute the literature that would support a magnitude of either symptomatic or asymptomatic cranial nerve injuries following such a procedure. Our study further fails to support a need for a more extensive exam ination that would routinely include indirect laryngoscopy and a specialist-ori ented consultation—both of which appear neither warranted nor cost effective.