Ligature of the Common Carotid Artery in Cancer of the Head and Neck

Abstract

Altlhough, ordiniarily, not difficult of execution, yet, the consequences which are liable to follow the -complete and permanent obstruction of one of the two vessels which supply the brain with the greatest share of its blood, will always render this operation a subject of grave consideration before its execution.Cerebral softening, with its concomitant symptoms, secondary hemorrhage, etc., are complications of the original disease for which ligature of the carotid may have been undertaken, which no prudent surgeon will heedlessly enicounter."Great importance was attaclhed to the operation by surgeons of this early period due to the variety of diseases and accidents for which it was undertaken.Patients with such common ailments as headache, neuralgia, epilepsy, and aortic aneurysm were considered suitable subjects for this operation regardless of its appallingly high mortality rate. The propriety of such operations was questioned by the more conservative surgeons, but the procedure became more and more popular up to the turn of the present century. Recently, few l)ertinent reports have appeared in the literature. The procedure is now much less common and the indications for its use are more limited. Improved technic has markedly reduced the postoperative mortality in tuncomplicated cases, but, as Doctor Wood foresaw, the operation continues to be a serious one, which requires grave consideration before its execution.Before discussing the present series of 20 cases, in which ligation of the common carotid became necessary, it might be interesting to examine briefly into the history of the operation itself. We know that the art of ligature for hemorrhage was known to the ancients, and Garrison20 states that: "Helio-

Carotid Resection and Reconstruction Associated with Treatment of Head and Neck Cancer

“…Some reports show no signifi cant diff erence of stroke risk in carotid artery ligation versus reconstruction (6,13). Others show a 30% to 50% mortality rate and stroke incidence with elective ligation (7,14). Meleca reported neurologic sequelae in 7 of 12 patients who underwent elective ligation versus 1 of 8 patients who underwent interposition graft reconstruction (15).…”

Balloon test occlusion and endosurgical parent artery sacrifice for the evaluation and management of complex intracranial aneurysmal disease

“…Excluding later refinements in the clamps that were used for testing cerebrovascular reserve and insufficiency prior to PAS, the carotid occlusion test remained essentially unchanged until the 1960s 11 12. A new era in carotid test and permanent occlusion evolved throughout this decade and into the early 1970s as innovative endovascular catheters and balloons were evaluated, and either embraced or abandoned as was the fate with the ingeniously designed magnetic field navigation catheters and detachable magnetic tip devices 13 14 15 16.…”

“…Before the availability of antibiotics and the practice of aseptic surgical technique, the short term mortality rate from either carotid resection or ligation in patients with diseases such as head and neck cancer, CCF and carotid aneurysms was frequently above 50% and as high as 55% 11 39. In the post-listerian era, the mortality rate greatly improved, ranging from 0% to 29% in series published between 1960 and 1981 in patients with intracranial aneurysms managed by carotid artery ligation 40.…”

Carotid Artery Surgery in the Treatment of Tumors of the Neck

“…Martin, 1 Watson,2 and McComb s (oncologists) have reported mor¬ talities in the neighborhood of 50% follow¬ ing ligation of the common or internal carotid arteries. Dandy,4 Sweet and Sarnoff5 (neurosurgeons) have reported mor¬ talities in the neighborhood of 10%.…”