A case of severe intracranial perfusion failure after a unilateral radical neck dissection

Abstract

Intracranial perfusion failure is one of the well-documented complications of bilateral radical neck dissection, but rarely occurs after unilateral radical neck dissection. We describe a male patient who had intracranial perfusion failure after unilateral radical dissection of the right side of the neck. Three days after the dissection, he complained of severe headache and nausea and then had increased blood and intracranial pressures. Carotid angiograms showed dominant right transverse sinus drainage probably because of hypoplastic left transverse sinus drainage. Furthermore, dissection of the right internal jugular vein caused occlusion at the superior bulb of the right jugular vein, leading to intracranial perfusion failure. The patient was treated by drainage of cerebrospinal fluid and a dehydrator and became asymptomatic. In our patient radical neck dissection done on the side of the dominant transverse sinus drainage, caused intracranial perfusion failure followed by severe headache and nausea, possibly because of the hypoplastic contralateral transverse sinus drainage.