Carotid Artery Resection Research Articles

Treatment of Symptomatic Carotid Webs

The present study aims to describe the clinical characteristics and treatment outcomes of patients with symptomatic carotid web treated at a single institution in South America. Retrospective study of a single-center experience of patients with carotid webs surgically treated from September 2019 to September 2023. 10 patients had carotid webs, six (60%) were females. Median age was 54.5 years (range: 35-77 years). All patients were symptomatic. Diagnosis was made in 90% (n=9) of the patients with either computed tomography angiography or magnetic resonance alone. One (10%) patient underwent angiography for definite diagnosis. The median interval from the first neurological event to intervention was 90 months (range: 3 days- 108 months). Four (40%) patients underwent surgical treatment within one month from symptom onset and carotid web diagnosis, with a median of 3.5 days (range: 3-9 days). Six (60%) patients underwent delayed surgical treatment since the cause of the neurological event was uncertain, with a median of 54 months (range: 6 - 108 months). These six patients had recurrent neurological events. Three (30%) patients underwent carotid endarterectomies with polyurethane patch and three (30%) by eversion technique. Three (30%) patients underwent segmental resection and reanastomosis of the internal carotid artery. One underwent internal carotid artery plasty with saphenous vein. At a median follow-up of 30 months (range: 6-46 months), one patient persists with mild aphasia, another patient has severe aphasia and right hemiparesis, both as sequalae of their initial strokes, and another patient has suffered 3 non-ischemic episodes of brief transient right hemiparesis attributed to epileptic seizures. The other seven patients remain without new neurological events. Neurological events of carotid distribution deserve accurate imaging work up, keeping in mind the diagnosis of carotid web. Surgical treatment for carotid web seems effective for preventing recurrences; nevertheless, further studies are warranted to define the best management for these patients.

Application of covered stent implantation combined with radical tumor resection in advanced head and neck squamous cell carcinoma involving the carotid artery: a comparative study with historical literature

Background Studies have shown that carotid artery reconstruction results in the best overall survival (OS) in Advanced Head and Neck Squamous Cell Carcinoma involving the Carotid Artery (AHNSCC-CA). Aims The purpose of this study was to evaluate the efficacy of covered stent implantation combined with radical tumor resection and to compare and analyze the historical literature on conventional carotid artery resection and reconstruction. Materials and methods A total of 68 patients with AHNSCC-CA were included in this study. This study compared the survival, local recurrence, surgical complications, and neurologic complications between the two groups. Results The OS rate at 12 months in the experimental group was 58.5% (median survival time: 15 months, 95% CI: 7.61–22.40). The OS rate at 12 months in the control group was 34.3% (median survival time: 8 months, 95% CI: 3.94–12.06, p = .371). In addition, the differences in the rates of local recurrence, surgical complications and neurological complications between the two groups were statistically insignificant (p = .677, p = .197 and p = .617). Conclusions and significance Compared with conventional carotid artery resection and reconstruction, covered stent implantation combined with radical tumor resection yields similar survival outcomes, but with significantly lower surgical risk and difficulty, and faster postoperative recovery.

Surgical management strategy for metastatic cervical lymph nodes surrounding the carotid artery in head and neck squamous cell carcinoma

Objective: To explore the surgical intervention strategy for metastatic cervical lymph nodes surrounding the carotid artery in head and neck squamous cell carcinoma. Methods: A total of 62 patients with advanced head and neck tumors and carotid wrap by disease treated in Department of Otorhinolaryngology and Head and Neck Surgery, the Affiliated BenQ Hospital of Nanjing Medical University between June 2019 and December 2023 were reviewed, of whom 9 patients presented with metastatic squamous cell carcinoma in cervical lymph nodes of unknown primary or with no recurrence of primary lesion and all the 9 patients were males, aged from 48 to 79 years old, with≤level 2 of Eastern Cooperative Oncology Group-Performance Status (ECOG-PS). Radiographically common carotid artery (CCA) and/or internal carotid artery (ICA) were surrounded by≥270° with tumor. All the 9 patients received implantation of covered stent in carotid artery and radical resection of metastatic cervical lymph nodes. The success rate, complications, surgery-related complications, local recurrence rate, quality of life (QOL) and overall survival (OS) were analyzed. The QOL of patients was compared by paired rank sum test, and P<0.05 indicated statistically significant difference. The OS was analyzed by Kaplan-Meier. Results: The success rate of stent implantation was 100%, with no implantation-related complications. R0 resection was performed in 8 cases and R1 resection in 1 case. The QOL of patients after surgery was improved, and the improvements in "pain", "mood" and "anxiety" were statistically significant(Z values were -2.236, -2.460 and -2.200, respectively, and all P values were<0.05). Follow-up was 1-18 months, with a median of 7 months, and 1 case was lost to follow-up. Local recurrence occurred in 3 patients with an incidence of 37.5% (3/8). OS was 59.9% at 12 months after surgery. Conclusion: Implantation of covered stent in carotid artery combined with radical resection is an effective method for the treatment of cervical lymph node metastasis.

Carotid Body Tumor Excision with and without Carotid Artery Reconstruction: Equivalency of 30-Day Outcomes over 12 Years in the American College of Surgery National Surgical Quality Improvement Program (ACS-NSQIP) Database

Background: Carotid body tumors (CBTs) are rare benign tumors that arise from the chemoreceptor tissue located at the carotid bifurcation that require excision if symptomatic. Depending on the size and location of the tumor, the carotid artery may need to be repaired after resection. This study aims to assess whether CBT excision with artery resection had higher rates of 30-day postoperative outcomes compared with CBT excision without artery resection. Methods: This is a retrospective cohort study. Patients were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) registry from 2005 to 2017. They were divided into two groups, based on Current Procedural Terminology (CPT®) codes: group A had CBT excision without carotid artery excision (CPT code 60600) and group B with carotid artery excision (CPT code 60605). Patient demographic characteristics, co-morbidities, and 30-days postoperative outcomes were compared between the two groups. Categorical data were analyzed using Pearson’s X2 or Fisher exact tests and presented as proportions (percentages). Continuous data were analyzed using parametric or non-parametric tests as appropriate. Statistical significance was defined as p &lt; 0.05. Statistical analysis was performed using the SPSS statistical software package. Results: A total of 463 patients were identified, 410 (88.4%) in group A and 53 (11.4%) in group B. Overall, there were 291 (62.9%) women. A higher proportion of women underwent CBT excision only, compared to men (91.1% [265/291] vs. 84.3% [145/172], p &lt; 0.0001). Demographics and comorbidities were similar between groups. There was no significant difference in the 30-day postoperative outcomes. The reoperation rate was higher in group B (3.8% vs. 1.5%, p = 0.334), while the readmission rate was higher in group A (3.2% vs. 0% p = 0.269), and both were not significantly different. Overall morbidity and serious morbidity were higher in group B (7.5% vs. 5.9%, p = 0.626) and lower in group A (5.7% vs. 3.9%, p = 0.544), respectively, but were not significantly different. Operative time (mean, SD) was higher in group B (187 ± 107 vs. 138 ± 66 min, p &lt; 0.001). However, the median (IQR) of hospital length of stay (LOS) was similar (2 [1, 4] vs. 2 [1, 3] days, p = 0.134). Conclusions: Overall, no difference was noted in the 30-day postoperative outcome between the two surgical approaches of CBT. However, operative time was longer when artery resection was performed. Further research to determine the factors predicting the need for carotid artery resection among patient gender is needed.

Tumor ablation including carotid artery resection and simultaneous reconstruction: A retrospective study

The study purpose is to review the surgical approach and evaluate the results in cases of head and neck malignancies with internal carotid artery invasion.The anatomical site of the primary tumor varied including a fixed massive metastatic neck disease of an occult intraoral carcinoma of the right tonsil, a recurrent metastatic neck tumor after laryngectomy for glottic primary carcinoma and a metastatic malignant melanoma of an unknown primary origin. In all cases carotid artery was invaded and therefore resected. An extended Javid shunt was performed between common carotid artery (CCA) and internal carotid artery (ICA) followed by CCA grafting with an interposition saphenous vein graft. In one case the vagus nerve was also grafted with an interposition sural graft.The total patient number was three. By clinical examination, follow-up and duplex scanning, the patency of the carotid grafts, vascular and non-vascular complications, disease recurrence and survival were analysed. Additionally, there was a double metachronous reconstruction for recurrence, giving the opportunity to study the graft adoption and response to disease.Internal carotid artery invasion portends a poor prognosis. The results show that carotid artery resection followed by the appropriate reconstruction yields a chance for cure or can provide reasonable palliation.

Carotid Artery Resection and Reconstruction due to Benign and Malignant Head and Neck Tumors.

Carotid resection for head and neck cancer is rare, and serious complications may arise since such cancer is frequently detected in advanced stages. The objective is to describe nine cases of carotid artery resection and reconstruction due to tumor invasion. The clinical records of nine patients who underwent carotid resection and reconstruction at our hospital were retrospectively reviewed. Carotid body tumors were evaluated with the aid of a vascular team in case carotid resection was necessary at the time of surgery. CT angiography to determine the status of the circle of Willis was performed in all patients who might undergo carotid resection and reconstruction in case of failure to restore cerebral blood flow and thus reduce possible sequelae due to ligation. Of nine patients, 6 had carotid body tumors, 1 had a thyroid tumor of conglomerate lymph nodes, 1 had a larynx tumor of conglomerate lymph nodes, and 1 had a myofibroblastic tumor. There were no intraoperative cerebrovascular accidents. One patient (11.1%) had a cerebrovascular accident secondary to carotid hematoma in the intermediate postoperative period that required vascular graft removal. One patient (11.1%) died seven days after surgery following an ischemic cerebrovascular accident. Eight patients remain asymptomatic, and 1 patient with recurrence and metastasis. Carotid resection remains a controversial issue in the treatment of advanced head and neck cancer. However, carotid resection and reconstruction are required for disease control, and complications such as thrombosis or vascular accidents may arise. Fortunately, this is a rare condition. We recommend carotid reconstruction for all patients in whom resection is required for tumor control. Ligation should be a last resort, as seen in the management of one of our patients.

Treatment experience of neck tumor surgeries involving carotid artery

Objective:To investigate surgical treatment of carotid artery diseases in neck tumor surgery. Methods:A retrospective analysis of the clinical data on carotid artery treatment was conducted in the five cases of neck tumor surgeries treated at Department of Surgical Oncology, the First Peoples Hospital of Lanzhou from March 2010 to May 2020. Surgical methods, including carotid artery resection and ligation, tumor-involved artery resection and vascular reconstruction, and tumor peeling and carotid rupture repairing were used, respectively. Results:Five cases were successfully operated on. One case of carotid artery ligation was followed by intermittent dizziness and decreased contra-lateral limb strength after the surgery. The remaining patients exhibited no neurological complications. A patient with cervical low-grade myofibroblastoma developed into lung metastases 8 months after the surgery. Another patient with cervical lymph node metastases in papillary thyroid cancer developed into lung metastases 24 months after the surgery. Conclusion:Currently, surgical methods for clinical treatment of diseased carotid arteries include carotid artery resection and ligation, simple tumor peeling, tumor invasion artery resection and vascular reconstruction, and interventional therapy. Each surgical method has its own advantages and disadvantages. Therefore, the choice of treatment depends on the patient's specific conditions, physician's clinical experience, and the equipment available.

PS-R03-9: PERIODIC PARALYSIS AS A PRESENTATION OF PRIMARY HYPERALDOSTERONISM: A CASE REPORT

Objective: the typical clinical presentations of patients with primary aldosteronism (PA) include generalized weakness, fatigue, high blood pressure and potassium deficiency. However, onset of PA with periodic paralysis is rare. Design and method: herein, we present the case of a 40-year-old, Caucasian women (BMI 25,6 kg/m2) with severe resistance arterial hypertension (BP 200–190/110–120 mmHg while taking antihypertensive drugs: valsartan 320 mg/day, bisoprolol 5 mg, hydrochlorthiasid 12,5 mg, amlodipin 10 mg/day, spironolacton 25 mg/day) and muscle weakness. Over the last 2 years prior to presentation, she had multiple such episodes of generalized weakness and losing the ability to stand up, move limbs, wich typically lasted for few minutes to hours/days and resolved spontaneously. Her blood pressure was uncontroled despite taking antihypertensive drugs. She was hospitalized several times because of these conditions, but there is no data on potassium levels during that period. Due to misdiagnosis, she was operated on twice (discectomy C5-C6, C6-C7 and resection of the right internal carotid artery due to pathological tortuosity), but her condition did not improve. Results: At the presentation U waves were registered in the electrocardiography the laboratory examination revealed low plasma potassium level (3,05 mmol/l). Serum TSH, cortisol level were normal. Pasma aldosteron level was 38,6ng/dl (n. 4–31). CT abdomen: adenoma of left adrenal gland. Surgical adrenalectomy was performed. Pathological diagnosis was a bening cortical adenoma. Outcomes: Patient's serum potassium level became normalized after surgical removal of adrenal adenoma. Patient's blood pressue is controlled (130/80 mmHg) by taking a fixed combination perindopril 10 mg/indapamid 2,5 mg/amlodipin 10 mg daily and there is no muscle weakness. Conclusions: Patients with periodic acute muscles weakness and arterial hypertension should monitor electrolyte levels, especially potassium, and evaluate for primary hyperaldosteronism to avoid delayed diagnosis and treatment.

Application of pedicle nasoseptal flap in endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma: an analysis of 39 cases

Objective: To explore the therapeutic effect and contributing factors of pedicle nasoseptal flap in endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma. Methods: Thirty-nine patients with recurrent nasopharyngeal carcinoma admitted to the Eye, Ear, Nose and Throat Hospital of Fudan University from July 2016 to July 2019 were reviewed, with 19 males and 20 females, aging from 30 to 75 years old. All patients underwent endoscopic nasopharyngectomy, followed by reconstruction with the pedicle nasoseptal flap. The methods of preoperative assessment, mucosal flap preparation and nasopharyngeal reconstruction were summarized, and factors affecting the survival of the pedicle nasoseptal flap were discussed. The rates between groups were compared by Fisher's exact test. Results: Ipsilateral mucosal flap was used in 19 cases while contralateral mucosal flap in 20 cases. After the operation, there were 33 cases with complete epithelialization and 6 cases with flap necrosis. Univariate analysis suggested that the number of radiotherapy courses was an important factor affecting the survival of flap (OR=7.429, 95%CI: 1.120-49.270, P=0.042). However, gender, age, type of transnasal endoscopic nasopharyngectomy, osteonecrosis, side of flap and internal carotid artery resection had no influence on flap survival (all P>0.05). All patients were followed-up for 24 to 60 months. Among them, 8 patients had local recurrence and then operated again, 4 patients survived with systemic metastases and 2 patients died. Conclusion: The pedicle nasoseptal flap is a good material for reconstruction for endoscopic nasopharyngectomy, but it is less effective for patients with multiple course radiotherapy.

Carotid bypass surgery for a persistent neck tumor after multiple treatments: a case report

Carotid artery involvement in head and neck cancer is challenging for surgeons and oncologists, particularly in recurrence or residual disease following multiple treatments. However, carotid artery resection and reconstruction can be safely performed in a carefully selected patient with local and regional control benefits despite the potential morbidity and high-risk complications. We presented a case of primary laryngeal cancer treated with chemoradiotherapy, modified radical neck dissection type I for residual neck node disease, and further chemotherapy. Although the primary laryngeal cancer showed a complete response, the residual neck tumor was still unresolved and even involved the carotid artery. Therefore, carotid resection with a combined saphenous vein graft and free flap reconstruction was the treatment of choice for this patient. It is effective and safe, and the risk of morbidity has been accepted.

Neuromonitoring in Neurosurgery : An imperative redemption

With the refinement in biomedical gadgetry, it has been a modern day requisite to safeguard the indigenous neuro-architecture and henceforth foretell the postoperative neurological outcome. The intraoperative neuro-physiological monitoring (IONM) comes as no surprise to be the only credible paradigm which can cluethe standing of neural pathway directly during general anesthesia. By engaging with the IONM appliance, the operating surgeon can acknowledge the risk of injury to critical neural structure while dealing with the pathology within its vicinity. Based on the province of the encephalon, a disparate methods of IONM such as MEP, SSEP, ABR, VEP, BCR, AMR etc have unfolded over time. Intraoperative monitoring of motor evoked potentials (MEPs) has been believed to be advantageousin preventing postoperative motor dysfunction while coping up with aneurysmal surgery involving the internal carotid artery (ICA) and middle cerebral artery (MCA) and resection of tumor near sensorimotor areas or corticospinal tract.3–6The fundamental essence of MEP monitoring is based on the detection of a pyramidal tract insult expressed as a decrease of the amplitude of the waveform elicited by electrical stimulation. Conversely, Somatosensory evoked potentials (SSEPs) embraces a series of wave forms that emulate sequential activation of neural structures along the somatosensory pathways.7 The representative stimulation sites classically used for clinical diagnostic in the course of SSEPs studies are the median nerve at the wrist, the common peroneal nerve at the knee, and the posterior tibial nerve at the ankle. Over and above that, SSEPs have been used as an indicator of cerebral ischemia during CEA, although far less commonly and as a surrogate alternative to EEG. SSEPs primarily gauge the integrity of the dorsal (sensory) column of the spinal cord. It furnishes with the real-time examination of spinal tracts at risk during surgical manipulation of the spinal cord such as spinal tumor and pedicle screw instrumentation. Likewise, Auditory brainstem response (ABR) is a test which can assess the brain wave activity and diagnose dysfunctions of the auditory pathways within the auditory nerve and brainstem that occurs in response to an stimuli with clicks or certain tones.8This is notably useful in the surgery of CP angle tumor such as vestibular schwannoma, Microvascular decompression for hemifacial spasm and trigeminal neuralgia. In any neurosurgical endeavour, where a visual field impairment is contemplated during the intraoperative period, the monitoring of flash visual evoked potential (VEP) comes as a rescue to evaluate the state of visual function.9This manoeuvre is explicitly virtuous while performing tumorectomy at the optic chiasm of pituitary adenomas, craniopharyngiomas, tuberculum sellae meningiomas, and other tumors; the removal of brain tumors from the optic pathway and structures in its vicinity such as the optic nerve, optic radiation, and occipital lobe; and clip ligation of aneurysm involving the internal carotid artery, which strike a pose of risking injury and impeding blood flow to the ophthalmic artery.9 Monitoring intraoperative flash visual evoked potentials (VEPs) estimate the functionality of the optic pathway from the retina to the visual cortical area, and hence allows visual impairment to be avoided or minimized. The bulbocavernosus reflex (BCR) is anillustrious somatic reflex that is convenient in gaining information about the state of the sacral spinal cord segments.10 When present, it is indicative of an intact spinal reflex arcs (S2–S4 spinal segments) with afferent and efferent nerves through the pudendal nerve. BCR is of the greatest utility for the monitoring of sacral function in detethering of the tethered cord syndrome.11 A surface electrode is used to electrically stimulate the pudendal afferent fibers at the clitoris or penis and recording of the analogous triggered EMG in external anal sphincter using a subdermal needle electrode. The abnormal muscle response (AMR), which is also known as lateral pread response, is adopted in the microvascular decompression (MVD) for hemifacial spasm.12A complete disappearance of AMR after a convincing MVD from root exit zone implicate a postoperative disappearance of the hemifacial spasm. Nonetheless, the persistence of the AMR does not mean incomplete MVD.

Carotid Artery Resection for Advanced Head and Neck Squamous Cell Carcinoma

Carotid Artery Resection for Advanced Head and Neck Squamous Cell Carcinoma

Resection of the internal carotid artery in selected patients affected by cancer of the skull base.

Invasion of the internal carotid artery (ICA) has been historically considered a criterion of non-resectability of skull base cancer (SBC). Patients affected by SBC who underwent surgery including resection of ICA at two tertiary institutions were included. Demographics, oncologic, and surgical information, complications, and survival outcomes were retrospectively reviewed. Survival outcomes were calculated. Ten patients were included. Three surgical approaches (transnasal endoscopic, transorbital, and transpetrosal) were employed to resect the invaded/abutted tract(s) of the ICA. All patients underwent ICA temporary balloon occlusion test. In two patients, an extracranial-to-intracranial arterial bypass was harvested. Major neuromorbidity was observed in two patients. Perioperative mortality of the series was 10.0%. Mean overall survival was 27.2months, with 2-year overall and progression-free survival rate of 88.9%. ICA resection is feasible as part of the ablation performed for very advanced SBCs. Survival outcomes are acceptable in adequately selected patients.

The Influence of Young Age on Difficulties in the Surgical Resection of Carotid Body Tumors

Simple SummaryThe aim of this study was to reveal the factors affecting the complexity and difficulties in performing surgery to resect carotid body tumors (CBTs). We analyzed 20 patients with 21 CBTs. We used the “same day surgery” procedure, including preoperative embolization of the feeding arteries in the morning and resection surgery in the afternoon of the same day. Four patients underwent resection of the carotid artery, followed by reconstruction. These four patients were between 18 to 23 years of age at the time of surgery. The mean blood loss and operative time in these patients differed significantly from those in older patients. These results indicated that young age may influence the difficulties faced in CBT surgery, resulting in an increased risk of carotid artery resection. The results obtained from our study could help surgeons safely and effectively perform resection surgery for CBTs.This study evaluated patient characteristics that affect the complexity and difficulties of performing surgery to resect carotid body tumors (CBTs). We retrospectively reviewed the medical records of 20 patients with 21 CBTs who were enrolled in the study. The median patient age was 46 years and the mean tumor diameter was 37.6 mm. The mean blood loss and operative time were 40.3 mL and 183 min, respectively. Four patients underwent resection of the carotid artery followed by reconstruction. These four patients were between 18 to 23 years of age at the time of surgery. The mean blood loss and operative time in these patients were 166 mL and 394 min, respectively, which differed significantly from those of older patients. Therefore, young age influenced the difficulties faced in surgical resection of CBT, with an increased risk of blood loss and carotid artery resection.

Circumferential Laryngotracheal Resection in Thyroid Cancer: Experience and Outcome in a Single Center.

There is limited experience of laryngotracheal resection in patients with differentiated thyroid carcinoma (DTC). The aim of this study was to report our experience of circumferential laryngotracheal resection in DTC and its long-term outcome. In this retrospective study, 10 patients of locally invasive DTC who underwent circumferential laryngotracheal resection between January 2000 and December 2015 were included. Clinicopathologic profile and follow up was noted. Mean age of the cohort was 50.1 ± 7.8years (M:F = 1: 2.3). Papillary carcinoma was the commonest pathology (60%) followed by follicular carcinoma (20%), 10% each had Hurthle cell and poorly differentiated thyroid carcinoma. Sixty percent patients presented with recurrent or persistent disease and 20% with distant metastases. Vocal cord palsy was observed in 30%. Fifty percent patients underwent tracheal resection with end to end anastomosis and remaining laryngotracheal resection. Carotid artery resection and anastomosis was performed in one patient. Shin stage IV invasion was observed in 80% and stage III in remaining. There was no perioperative mortality. All patients received adjuvant radioiodine therapy and 40% external beam radiotherapy. Median follow up was 48months. One patient who earlier had tracheal resection underwent total laryngectomy due to recurrent disease after 24months. Forty percent patients developed distant metastases during follow-up. Mean survival was 77.8months (CI = 63.0-92.5). Five-year overall survival was 60% and was significantly high in those without distant metastases (p = 0.006). The outcome of circumferential larygotracheal resections for DTC is excellent in terms of local disease control and long term survival.

Method of surgical treatment of patients with combined pathological tortuosity of the common and internal carotid arteries

Pathological tortuosity of the internal carotid artery ranks next to atherosclerosis amongst causes leading to development of ischaemic strokes. In some patients pathological tortuosity of the internal carotid artery is combined with pathological kinking of the common carotid artery. Existing methods of surgical treatment for such concomitant pathology include stegewise elimination of kinking of the internal then common carotid artery, with two anastomoses sequentially formed, thus increasing the overall duration of arterial cross-clamping an prolonging cerebral ischaemia. Another method consists of resection of the common carotid artery with bringing down its bifurcation, restoration of straightness of the internal carotid artery, and formation of an end-to-end anastomosis. The second technique is often associated with technical requirement for ligation of the external carotid artery. In the presence of prolonged atherosclerotic lesions of the bifurcation of the internal and external carotid arteries, this method does not always allow carrying out adequate endarterectomy and fix the intima of the internal carotid artery distal to the bifurcation. The authors developed a method of surgical treatment of patients with a combination of pathological kinking of carotid arteries, providing herein a detailed description of the procedure of performing an operation according to an original technique. The proposed method of reconstruction makes it possible to eliminate pathological kinking of the common and internal carotid arteries in single cross-clamping of vessels, to preserve patency of the external carotid artery and in the presence of an atherosclerotic lesion of the bifurcation to perform adequate endarterectomy. Over the period from 2015 to 2019, a total of 10 patients were operated on according to this technique at the Municipal Vascular Centre of Samara, with no postoperative complications observed. The proposed technique of a reconstructive operation may be effectively used in patients with cerebral ischaemia in concomitant pathological kinking of the common and internal carotid arteries.

Resection of Internal Carotid Artery and Dissection Septum With Reimplantation Into Common Carotid Artery for Symptomatic Internal Carotid Artery Dissection

Resection of Internal Carotid Artery and Dissection Septum With Reimplantation Into Common Carotid Artery for Symptomatic Internal Carotid Artery Dissection

Analysis of the effect of one-stage revascularization with internal carotid artery resection on cervical metastatic carcinoma in advanced head and neck carcinomas

Objective:To analyze the therapeutic effect of internal carotid artery resection and one-stage revascularization in advanced cervical metastatic carcinoma. Method:Twenty-one patients with advanced head and neck malignant tumors who underwent internal carotid artery resection and one-stage revascularization were analyzed retrospectively. Among those, 11 patients suffered from hypo-pharyngeal carcinomas, 5 laryngeal carcinomas, 2 external auditory carcinomas, 1 middle ear carcinoma, and 2 parotid gland carcinomas. All patients received CT, MRI, DSA and other examinations before operation. It was found that all the internal carotid artery walls had been invaded by tumors, and there were different degrees of lumen stenosis. Autogenous saphenous vein grafts were used in 18 cases; artificial vessels were used in 3 cases. After revascularization, pedicled or free flaps were used to protect the anastomotic areas. All patients were treated with radiotherapy and chemotherapy according to different situations. Result:Among the 21 cases, 16 cases underwent reconstruction of cervical segment internal carotid and 5 cases were the skull base segment internal carotid. Twenty patients were successfully reconstructed in the first stage, and no vascular reconstruction-related nervous system complications occurred after operations. Postoperative imaging showed that the reconstructed blood vessels were well recanalized, with a success rate of 95.2%（20/21）. Only 1 case received ligation of internal carotid artery after the failure of vascular reconstruction. Among all the cases, the 1-year survival rate and 3-year survival rate were 90.5% and 40.4%, respectively. Conclusion:In patients with advanced head and neck malignant tumors with cervical metastatic cancer invading the internal carotid artery, one-stage revascularization after radical resection of the tumor and the internal carotid can achieve good therapeutic effect. Careful preoperative evaluation, proficient vascular anastomosis technology, adequate risk assessment and prevention are the key to the success of the operations.

Surgical Treatment of a Patient with Invasion of Multiple Organs Including the Common Carotid Artery by Papillary Thyroid Carcinoma: Surgical Management for Invasion of the Aerodigestive Tract

Background: Extrathyroidal invasion has the greatest negative prognostic impact among several adverse prognostic factors of differentiated thyroid carcinoma (DTC). Surgical treatment for locally advanced DTC is challenging. In particular, the presence of great vessel involvement makes it more challenging, with vessel rupture and infection being common occurrences, especially in patients with laryngotracheal or esophageal intraluminal invasion.1 Locoregional tumors presenting with great vessel and/or multiple organ invasion have been deemed to be unresectable. However, there has been little discussion regarding which types of locoregional tumor are unresectable. Regarding the surgical management of aerodigestive invasion, the 2015 American Thyroid Association management guidelines state that surgical decision making can be complex and must balance oncologic surgical completeness with preservation of the upper aerodigestive tract head neck function. However, surgical management of aerodigestive tract invasion remains controversial.2 Materials and Methods: A right thyroid tumor was unexpectedly detected in a 77-year-old man by computed tomography images. The man was found to have papillary thyroid carcinoma (PTC) by fine needle aspiration biopsy. He was referred for the surgical treatment of multiple organ invasion by PTC. Tumor encasement of about 180° of the right common carotid artery and aerodigestive tract invasion were suspected on pre-operative magnetic resonance imaging. We performed total thyroidectomy, including resection of multiple organ infiltration and right lateral neck dissection. Our surgical strategy for locally advanced DTC is implemented with curative surgical intent for all patients and functional preservation or reconstruction, if possible. Results: The thyroid tumor infiltrated the right common carotid artery, internal jugular vein, prevertebral fascia, pharyngoesophagus, laryngotrachea, and right recurrent laryngeal nerve (RLN). We performed subadventitial resection of the common carotid artery, partial prevertebral fascia resection, muscle layer resection of the pharyngoesophagus, framework resection of the larynx, window resection of the trachea from first to fourth ring, and resection and intralaryngeal reconstruction of the right RLN.3 After tumor resection, the right common carotid artery was covered using a deltopectoral flap and separated from the tracheacutaneous fistula. Pathology analysis confirmed well-differentiated PTC, which was classified as pT4bN1bM0. The tracheocutaneous fistula was closed 2 months after surgery. The patient underwent radioactive iodine (RAI) adjuvant therapy of 100 mCi, 6 months after surgery. RAI uptake was noticed in only the thyroid bed. Maximum phonation time was 10 seconds, 6 months after surgery. Conclusions: This video illustrates the technical details of surgical management for invasion of the aerodigestive tract. These surgical techniques are effective for improving surgical curability and functional preservation. No competing financial interests exist. Runtime of video: 9 mins 29 secs

Clinical features and surgical treatment of neurilemmoma versus carotid body tumors at bifurcation of carotid artery

To analyze clinical features, surgical treatment and outcomes of neurilemmoma and carotid body tumors in bifurcation of carotid artery. The clinical data of 17 patients with neurilemmomas and 76 patients with carotid body tumors at the bifurcation of carotid artery, who were surgically treated in Zhongshan Hospital of Fudan University from March 2012 to November 2016, were retrospectively analyzed. The clinicopathological characteristics, surgical procedures and outcomes were compared between two groups. No difference of preoperative clinical demographic data was found between two groups. Operation time of the neurilemmoma group was significantly shorter than that of the carotid body tumor group[(93.9±30.8) min vs. (159.3±52.9) min, P<0.01]. The neurilemmoma group had lower volume of intra-operative blood loss[(110±96) mL vs. (356±239) mL, P<0.01] and lower rate of external carotid artery resection (11.8% vs. 68.4%, P<0.01) than the carotid body tumor group. In the neurilemmoma group, 17 tumors were completely resected and no malignant disease was found. In the carotid body tumor group, 76 patients underwent complete surgical resection for the tumor, of which 5 (6.6%) were malignant. Tumor size of the neurilemmoma group was larger than that of the carotid body tumor group[(4.5±1.4) cm vs. (3.1±1.0) cm, P<0.01]. There was no significant difference in the incidence of peri-operative complications and length of hospital stay between two groups (P>0.05). The clinical manifestations of neurilemmoma and carotid body tumors at carotid artery bifurcation are similar. The carotid body tumor group has a longer operating time, larger intra-operative blood loss, higher external carotid resection rate and relative higher incidence of malignancy. More cautions should be given when carotid body tumors at carotid artery bifurcation are treated.