Salvage of advanced squamous cell carcinomas of the head and neck: internal carotid artery sacrifice and extracranial–intracranial revascularization

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Squamous cell carcinoma (SCC) of the head and neck may involve the carotid artery (CA) in the neck or skull base. Whether tumor resection should be associated with sacrifice of the CA is debatable.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Records obtained in five consecutive patients (three men, and two women; mean age 58 years, range 47–69 years) treated for recurrent or progressive SCC involving the internal carotid artery (ICA) at the skull base were reviewed retrospectively. The ICA was sacrificed, an extracranial–intracranial (EC–IC) bypass was performed using a saphenous vein graft, and the tumor and involved ICA segment were resected.</jats:p> <jats:p>Gross-total resection of the SCC was achieved in four cases. One patient died of an acute postoperative stroke due to bypass occlusion and did not undergo tumor resection. No other permanent ischemic or neurological deficits were noted. The other four patients died of tumor progression (survival range 2–40 months, mean 14 months). One patient survived for more than 2 years (2-year overall survival rate 20%). Histological tumor invasion of the CA wall was verified in one of the three evaluated specimens.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>A high rate of morbidity and mortality is associated with cases in which skull base CA sacrifice and an EC–IC bypass are performed. Not all resected arteries are shown to have malignant infiltration on histological examination. Better preoperative imaging criteria are needed to define malignant infiltration of the ICA at the skull base. Chemotherapy and radiotherapy without aggressive tumor resection may be an option for these patients.</jats:p></jats:sec>

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

“…However, only 5 of these 9 patients were analyzed for survival outcomes; the other 4 were described as a part of a technical report. 9,11,39 The MRI studies showed that the infratemporal ICA was involved by tumor in 9 patients, the petrous ICA in 3 patients, and the cavernous ICA in 6 patients. All patients underwent preoperative angiography, but their cerebrovascular reserve was not evaluated because vascular reconstruction was planned in all cases.…”

A Novel Strategy to Engineer Small‐Diameter Vascular Grafts From Marrow‐Derived Mesenchymal Stem Cells

“…In patients with an artery severely affected by atherosclerosis or after carotid artery resection due to tumor invasion, vessel transplantation is the surgical mainstay of therapy (1)(2)(3)(4)(5)(6)(7). The preferred bypass substitute is the patient's own vessels.…”

EC‐IC bypass for cerebral revascularization following skull base tumor resection: Current practices and innovations

“…Fifteen articles were added to the study from searching the references of papers encountered through the literature search. After the second group reviewed the remaining 78 articles, 27 were selected that had sufficient data about extracranial‐intracranial bypass for tumors that could be analyzed in the final review (Table ) …”