ABSTRACT
OBJECTIVES: The objective of this prospective study was to evaluate the incidence and distribution of cranial nerve injuries after carotid eversion endarterectomy (EEA) performed under regional anaesthesia using a transverse skin incision. PATIENTS AND METHODS: The study included 165 patients and 180 carotid arteries. All patients had a standard pre-operative assessment performed by a neurologist and ENT specialist. All carotid endarterectomies were performed by the eversion technique under regional anaesthesia. RESULTS: Ten cranial nerve injuries were observed. Seven patients had injuries of the marginal mandibular branch of the facial nerve, two patients had lesions of the hypoglossal nerve, and one patient had an injury of the recurrent laryngeal nerve. Eleven patients developed hoarseness without cranial nerve injury. Injuries of the marginal mandibular branch recovered after 3-8 months (mean 5.2 months). Both hypoglossal nerve injuries recovered after 4 months. The patient with the recurrent laryngeal palsy had no improvement after 19 months. Patients with hoarseness secondary to laryngeal haematoma recovered within 1 month. CONCLUSION: 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.
Subject(s)
Anesthesia, Conduction , Cranial Nerve Injuries/etiology , Cranial Nerve Injuries/surgery , Dermatologic Surgical Procedures , Endarterectomy, Carotid , Postoperative Complications/etiology , Postoperative Complications/surgery , Reoperation , Skin/pathology , Aged , Aged, 80 and over , Carotid Artery, Internal/surgery , Carotid Stenosis/epidemiology , Carotid Stenosis/surgery , Cranial Nerve Injuries/epidemiology , Facial Nerve Injuries/epidemiology , Facial Nerve Injuries/etiology , Facial Nerve Injuries/surgery , Female , Follow-Up Studies , Hematoma/epidemiology , Hematoma/etiology , Hematoma/surgery , Humans , Hypoglossal Nerve/diagnostic imaging , Hypoglossal Nerve/surgery , Hypoglossal Nerve Injuries , Incidence , Laryngeal Nerve Injuries , Laryngeal Nerves/diagnostic imaging , Laryngeal Nerves/surgery , Laryngoscopy , Male , Middle Aged , Paralysis/epidemiology , Paralysis/etiology , Paralysis/surgery , Postoperative Complications/epidemiology , Prospective Studies , Recurrence , Skin/diagnostic imaging , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
We performed 99mTc-HMPAO SPECT in a patient during transient global amnesia and twice thereafter. SPECT during the attack showed a significant diminution of regional blood flow in the left thalamus and a less marked diminution in the right thalamus. Quantitative evaluation of global 99mTc-HMPAO uptake indicated a diffuse depression of cerebral blood flow. At follow-up to 40 days after the attack, global uptake and thalamic flow indices normalized, but there was a persistent reduction of left frontal flow values.
