Introduction: Resection of the cancer and the involved artery in the neck has been applied with some success, but the indications for such an aggressive approach at the skull base are less well defined.
Methods: We retrospectively reviewed the charts of all patients with advanced head and neck cancers who underwent ICA sacrifice with revascularization using extra-cranial-to-intracranial (EC-to-IC) bypass between 1995 and 2010 at our Institute.
Results: Eighteen patients were identified. There were 4 sarcomas and 14 carcinomas that involved the ICA at the skull base. All patients underwent ICA sacrifice with revascularization. One patient died from a stroke after revascularization. A second patient died from consequences of a fistula between the oral and cranial cavities (surgical mortality rate 11.1%). Eight months after the operation, one patient developed occlusion of the bypass and died. Complications associated with the bypass surgery included one case of subdural hematoma with blindness, one case of status epilepticus, and one case of asymptomatic bypass occlusion (bypass morbidity 16.7%). In one patient treated with adjuvant therapy before surgery, we identified only radiation effect and no tumor upon resection. In a second patient, the bypass was occluded and his tumor was not resected. The other 16 patients underwent gross total resection of their tumor. Excluding the surgical deaths, the mean and median length of survival series was 13.2 and 8.3 months, respectively. Including the surgical deaths, the mean and median length of survival was 11.8 and 8 months, respectively (range 17 days-48 months).
Conclusions: Despite maximal surgical intervention, including ICA sacrifice at the skull base with revascularization, patient survival was dismal and the complication rate was significant. We no longer advocate such an aggressive approach in this patient population. On a rare occasion, however, such an approach may be considered for low-grade malignancies.
Patient Care: My research illustrates that aggressive resection of the carotid artery and revascularization for head and neck malignancies should only be reserved for low grade pathologies and is associated with a high risk without changing patient outcomes in cases of high grade pathology.
Learning Objectives: To discuss the role of carotid sacrifice in treating aggressive head and neck tumors at the skull base.