Cerebral revascularization and carotid artery resection at the skull base for treatment of advanced head and neck malignancies

Abstract

Despite maximal surgical intervention, including ICA sacrifice at the skull base with revascularization, patient survival was dismal, and the complication rate was significant. The authors no longer advocate such an aggressive approach in this patient population. On rare occasions, however, such an approach may be considered for low-grade malignancies.

Role of and Indications for Bypass Surgery After Carotid Occlusion Surgery Study (COSS)?

“…Соотношение риск/польза при полной резекции в сочетании с шунтированием по сравнению с частичной резекцией свидетельствует в пользу частичной резекции и адъювантной лучевой терапии или химиотерапии [16,17].…”

“…Операция шунтирования в настоящее время осуществляется толь-ко в отдельных и редких случаях, в которых важно рассматривать вопрос о том, насколько радикальная резекция плюс удаление участка артерии и шунтирова-ние улучшают выживаемость с сохранением хорошего качества жизни и перевешивают риски [3,[16][17][18].…”

“…Bypass surgery is currently performed only in selected and rare cases, in which it is of importance to consider whether the benefit of radical resection plus arterial sacrifice and bypass improves survival with good quality of life and outweighs the risks. 3,[16][17][18] …”

“…16 The risk/benefit ratio for complete resection combined with a bypass versus partial resection has evolved in favor of partial resection and adjuvant radiotherapy or chemotherapy. 16,17 Thus, flow preservation bypass for skull base tumors has declined in frequency during the last decades. Bypass surgery is currently performed only in selected and rare cases, in which it is of importance to consider whether the benefit of radical resection plus arterial sacrifice and bypass improves survival with good quality of life and outweighs the risks.…”

Surgical management of skull base tumors

“…Patients with atypical and more aggressive tumors may require radical resections with ICA sacrifice and cerebral revascularization. 36,37 Adjuvant therapy with stereotactic radiosurgery has shown good control rates for skull base meningiomas and can be considered in patients with tumor progression whose tumors are not amenable to surgical resection. Radiosurgery, including heavy charged particle irradiation, play an important role as an adjuvant to the management of cavernous sinus lesion, however it is beyond the scope of this work.…”