Abstract
Cerebral stroke continues to be one of the leading causes of mortality and long-term morbidity; therefore, carotid endarterectomy (CEA) remains to be a popular treatment for both symptomatic and asymptomatic patients with carotid stenosis. Cranial nerve injuries remain one of the major contributor to the postoperative morbidities. Anatomical dissections were carried out on 44 sides of 22 cadaveric heads following the classical CEA procedure to investigate the variations of the local anatomy as a contributing factor to cranial nerve injuries. Concurrence of two variations was found to be important in hypoglossal nerve injury: the presence of a direct smaller vein in proximity of the carotid bifurcation, and the intersection of the hypoglossal nerve (HN) with this vein. Based on the sample investigated, this variation was observed significantly higher on the right side. Awareness of possible anatomical variations and early ligation of any small veins can significantly decrease iatrogenic injury risk.
Highlights
Accepted: 4 February 2021Cerebral stroke continues to be one of the leading causes of mortality and longterm morbidity [1]
Materials and Methods sides of the 22 formalin-fixed cadaveric heads were prepared for anatomical dissection at the Department of Neurosurgery, “Center for Advanced Simulation and Education (CASE), Neuroanatomy Lab” at Acibadem MAA University
In 20 of the 44 sides, there were more than one branches of the internal jugular vein (IJV) identified within the surgical exposure (45.5%) (Table 1)
Summary
Accepted: 4 February 2021Cerebral stroke continues to be one of the leading causes of mortality and longterm morbidity [1]. The results have improved over the last three decades, the incidence of cranial nerve injuries remain high due to the surgical area containing multiple vital structures and the wide variations that can be seen on these structures [3]. Knowledge of the local anatomy should be at the utmost level. In the last 35 years, the incidence rate of cranial injuries has been lowered significantly, the hypoglossal nerve (HN) from 8% to 2% and the vagus from 8% to
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