Head and neck squamous cell carcinomas may involve the carotid artery. Surgical treatment of these tumors is a difficult challenge, because of related morbidity and mortality. The aim of this study of international literature was to define the best preoperative and intraoperative strategy which permits carotid resection with acceptable neurologic risk. Pre-operative evaluation of cerebral tolerance to carotid occlusion is performed. If the patient has successfully completed the 30-minute temporary occlusion of the internal carotid artery, a permanent balloon occlusion is performed. Surgical treatment includes carotid resection with or without revascularization using an autogenous graft. Elective carotid resection without reconstruction results in cerebral complications in 0 to 25% of patients, and death in 0 to 30% of patients. If a reconstruction using a graft is performed, cerebral complications occur in 0 to 22% of patients, and death in 0 to 33% of patients. Anastomotic rupture occurs in 0 to 33% of patients. However, many authors reported no neurologic complications and no deaths after performing successful preoperative permanent balloon occlusion of the internal carotid associated with carotid resection. Carotid resection can be performed with an acceptable cerebral risk in selected patients. Preoperative carotid occlusion seems to result in decreased postoperative mortality and morbidity rates. Prospective studies should be done to clarify the benefit of this procedure.
Copyright John Libbey Eurotext 2003.