Incidence of Cranial Nerve Injuries after Carotid Eversion Endarterectomy with a Transverse Skin Incision under Regional Anaesthesia

Assadian, Afshin; Senekowitsch, C.; Pfaffelmeyer, N.; Assadian, Ojan; Ptakovsky, H.; Hagmüller, G. W.

doi:10.1016/j.ejvs.2004.06.019

Cited by 58 publications

(27 citation statements)

References 13 publications

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“…The incidence of the recurrent laryngeal nerve branch ranged from Ͻ1% to 6% for thyroidectomy, from Ͻ1% to 8% for carotid endarterectomy, and from 1.3% to 2.6% for anterior cervical spine surgery. 4,[9][10][11][12] The recurrent laryngeal fibers are medially placed in the vagal trunk. 3,13 For anterior variation, the VN was superficial and medial to the CCA, and nerve injury may occur during dissection by a diathermy burn or mechanical stretching during carotid endarterectomy.…”

Section: Discussionmentioning

confidence: 99%

Variations in the Course of the Cervical Vagus Nerve on Thyroid Ultrasonography

Park

Jeong²,

Lee³

et al. 2011

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 99%

Variations in the Course of the Cervical Vagus Nerve on Thyroid Ultrasonography

Park

Jeong²,

Lee³

et al. 2011

AJNR Am J Neuroradiol

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“…[20][21][22] To our knowledge, this is the first study of CEA scar outcomes using the validated POSAS.…”

Section: Limitationsmentioning

confidence: 99%

Patient and observer scar assessment scores favour the late appearance of a transverse cervical incision over a vertical incision in patients undergoing carotid endarterectomy for stroke risk reduction

Deck

Kopriva

2015

cjs

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Background: Carotid endarterectomy (CEA) is a very common operation, but there is no agreement on the appropriate orientation of the surgical incision. Methods:We retrospectively reviewed the charts of patients who had undergone CEA between Jul. 1, 2010, and Dec. 31, 2013. We contacted patients identified in the review to solicit participation in a clinical follow-up examination, during which the esthetic outcome of the scar was evaluated using the Patient and Observer Scar Assessment Scale (POSAS).Results: During the study period 237 CEAs were performed. Nine patients refused the use of their personal health information in this study. There were no significant differences in the neurologic outcomes of patients based on the incision orientation (perioperative stroke and death 1.4% with transverse incision v. 0% with a vertical incision, p = 0.44). Fifty-two patients presented for follow-up examination. Thirty-three had a transverse incision and 19 had a vertical incision. Results of the POSAS significantly favoured the transverse incision (p = 0.03). Vertical incisions were more often associated with persistent, mild marginal mandibular nerve dysfunction (p = 0.04). Conclusion:Carotid endarterectomy performed through a transverse skin incision compared with a vertically oriented skin incision is associated with improved esthetic outcome, as measured by the POSAS, without an observed statistically significant difference in the risk of perioperative stroke or death between the 2 techniques.Contexte : L'endartériectomie de la carotide est une intervention chirurgicale très courante. Toutefois, il n'existe aucun consensus sur l'orientation de l'incision.Méthodes : Nous avons analysé rétrospectivement les dossiers de patients ayant subi une endartériectomie de la carotide entre le 1 er juillet 2010 et le 31 décembre 2013. Nous avions communiqué au préalable avec les patients concernés pour solliciter leur participation à un examen de suivi clinique au cours duquel le résultat esthétique de leur cicatrice serait évalué au moyen de l'échelle d'évaluation des cicatrices par les patients et les observateurs (POSAS).Résultats : Au cours de la période visée, 237 endartériectomies de la carotide ont été pratiquées. Neuf patients ont refusé qu'on utilise leurs renseignements médicaux personnels dans le cadre de l'étude. Aucune différence significative n'a été observée quant aux capacités neurologiques des patients selon l'orientation de leur incision chirurgicale (décès et accident vasculaire cérébral périopératoires : 1,4 % avec incision transversale contre 0 % avec incision verticale, p = 0,44). Au total, 52 patients se sont présentés pour un examen de suivi : 33 avaient eu une incision transversale et 19, une incision verticale. Les résultats à la POSAS étaient nettement meilleurs pour les incisions transversales (p = 0,03). Les incisions verticales étaient plus souvent associées à un dysfonctionnement léger, mais persistant de la branche marginale de la mandibule du nerf facial (p = 0,04). Conclusion :Notre étude indique...

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“…Proponents of the retrojugular approach for CEA emphasise the shorter operative time and ease of dissection, especially in high carotid lesions. 3,4 The carotid artery can be exposed without division of any major branches of the internal jugular vein and lymphatic structures are avoided with this technique. Furthermore, the internal carotid artery is encountered in a plane superficial to the external carotid artery and a high exposure of the vessel may be achieved without mobilisation of the hypoglossal nerve.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, absence of posterior branches of the internal jugular vein and decreased need for mobilisation of the hypoglossal nerve may create shorter operating times. 3,4 Concerns, however, have been postulated with regard to the high incidence of cranial nerve injury resulting from a different dissection area, especially damage to the accessory nerve and branches of the vagus nerve. [5][6][7][8] The objective of the present study was to conduct a systematic review of the literature and perform a meta-analysis of the outcomes of CEA using the antejugular and retrojugular approach.…”

mentioning

confidence: 99%

Meta-analysis of retrojugular versus antejugular approach for carotid endarterectomy

Antoniou¹,

Murray²,

Antoniou³

et al. 2014

annals

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INTRODUCTIONThe retrojugular approach for carotid endarterectomy (CEA) has been reported to have the advantages of shorter operative time and ease of dissection, especially in high carotid lesions. Controversial opinion exists with regard to its safety and benefits over the conventional antejugular approach. METHODS A systematic review of electronic information sources was conducted to identify studies comparing outcomes of CEA performed with the retrojugular and antejugular approach. Synthesis of summary statistics was undertaken and fixed or random effects models were applied to combine outcome data. FINDINGS A total of 6 studies reporting on a total of 740 CEAs (retrojugular approach: 333 patients; antejugular approach: 407 patients) entered our meta-analysis models. The retrojugular approach was found to be associated with a higher incidence of laryngeal nerve damage (odds ratio [OR]: 3.21, 95% confidence interval [CI]: 1.46-7.07). No significant differences in the incidence of hypoglossal or accessory nerve damage were identified between the retrojugular and antejugular approach groups (OR: 1.09 and 11.51, 95% CI: 0.31-3.80 and 0.59-225.43). Cranial nerve damage persisting during the follow-up period was similar between the groups (OR: 2.96, 95% CI: 0.79-11.13). Perioperative stroke and mortality rates did not differ in patients treated with the retrojugular or antejugular approach (OR: 1.26 and 1.28, 95% CI: 0.31-5.21 and 0.25-6.50). CONCLUSIONS Currently, there is no conclusive evidence to favour one approach over the other. Proof from a well designed randomised trial would help determine the role and benefits of the retrojugular approach in CEA.

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Incidence of Cranial Nerve Injuries after Carotid Eversion Endarterectomy with a Transverse Skin Incision under Regional Anaesthesia

Abstract: The incidence of cranial nerves injury after carotid EEA under regional anaesthesia is comparable to that reported for conventional carotid surgery. Postoperative hoarseness is most frequently due to laryngeal haematoma.

Cited by 58 publications

References 13 publications

Variations in the Course of the Cervical Vagus Nerve on Thyroid Ultrasonography

Variations in the Course of the Cervical Vagus Nerve on Thyroid Ultrasonography

Patient and observer scar assessment scores favour the late appearance of a transverse cervical incision over a vertical incision in patients undergoing carotid endarterectomy for stroke risk reduction

Meta-analysis of retrojugular versus antejugular approach for carotid endarterectomy

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