Perioperative Stroke in Patients Undergoing Head and Neck Surgery

Abstract

The risk of perioperative strokes has been demonstrated to be very low in general surgical procedures, and somewhat higher in cardiac and carotid artery procedures. We describe 5 patients who underwent major head and neck procedures not requiring carotid ligation and who postoperatively suffered strokes. These occurred between the first and ninth postoperative days. Four of the patients were thought to have had emboli, 3 to the cerebral hemispheres (2 ipsilateral and 1 contralateral to the neck dissections), and another to the lower brain stem. Hypoperfusion was thought to have caused the stroke in the fifth patient. All patients had risk factors for stroke. The cases in our series were difficult to diagnose because of the delayed onset and subtle nature of symptoms, as well as masking of speech and communication due to the operative involved. Thrombogenesis within the internal carotid and vertebral artery systems due to patient positioning and intraoperative cervical manipulation may be an important etiologic factor in this form of stroke.

Peri‐operative stroke in general surgical patients

“…atrial fibrillation). The incidence of perioperative stroke varies from 0.8% to 3.0% in peripheral vascular surgery [13][14][15] and rises to 4.8% in head and neck surgery [16], presumably due to the age and other associated risk factors of these patients.…”

“…However, Nosan et al [16] reported a 4.8% incidence of peri-operative stroke in patients undergoing head and neck surgery, especially those requiring resection of head and neck tumours and suggested that this higher incidence may be partly due to the elderly age of the patients and hyperextension of the patient's neck associated with distortion and vasospasm of the vertebral and internal carotid arteries intra-operatively.…”

Preoperative Doppler sonography for prevention of perioperative stroke in head and neck cancer patients undergoing neck dissection: Is it beneficial?

“…8,9 Nosan et al 8 described 5 patients who suffered a postoperative stroke after undergoing head and neck surgery. Their case series was drawn from a center where 105 patients had undergone a neck dissection between 1989 and 1991, yielding an incidence of approximately 4.8%.…”

Postoperative coma in a patient with complete basilar syndrome after anterior cervical discectomy

“…12,13 Intracranial vertebrobasilar artery dissection is much more frequent than previously believed, and can be asymptomatic in as many as 10% of patients, 14 while intraoperative malpositioning of the neck has been implicated as a precipitating factor for dissection and/ or thrombosis. [15][16][17][18] Rotation 19 and hyperextension 20 of the neck induce potentially harmful flow changes in the posterior circulation, and is associated with a higher incidence of infarctions in subjects with hypoplastic vertebral arteries (HVA). 20 Since HVA has been estimated to occur in at least 25% of patients who are considered high-risk for cerebral vascular disease, 20 it presents a major risk factor for posterior circulation ischemia, 21 especially when combined with malpositioning of the neck.…”