Safety Evaluation Of Operation For Head And Neck Neoplasms Involving The Carotid Arteries

ObjectiveTo provide a suit systematic and individual preoperative evaluation for the safety of head and neck neoplasms after various examination of 32 cases.MethodsThis study collect 32 patients with different head and neck neoplasms involving the carotid arteries from January 2007 to December 2008, pathological (or cytological) examination was used to identify the nature of tumor , enhanced CT was used to find the form and the part where it involved. when enhanced CT did not identify the relation of the tumor and carotid arteries, CT angiography was used to find whether the blood vessel was encroachment, whether there was mural thrombosis in the blood vessel, whether the blood vessel was to be unobstructed . especially to find the relationship between the tumor and carotid arteries, the relationship between the tumor and the arteria vertebralis, the relationship between the tumor and thyrocervical trunk, and to know the condition of Willis circle. Other more evaluations were used if the tumor encroach common carotid artery or internal carotid artery. Digital subtraction angiography (DSA), balloon test occlusion(BTO),carotid back pressure were used to find the function of carotid artery and compensation condition of opposite side Cerebral vessels. If carotid artery has part function and the patient was squamous carcinoma or recidivation postradiotherapy, it difficult to decoherence the squamous carcinoma from carotid artery. So reconstruction of carotid artery must be prepare for those could not pass evaluation. Resection of carotid artery could be used if it was nonfunction or uninjured side was compensatory.Results(1)The Results of enhanced CT:a total of 32 patients examined by means of enhanced CT and 13 cases complete preoperative evaluation. The 13 cases including tumor only encroach arteria carotis 3 cases;tumor involved common carotid artery or internal carotid artery,but there was interspace between them 4 cases;tumor main involved internal carotid artery and part involved external carotid artery 6 case. Other 3 cases with tumor involved common carotid artery and internal carotid artery refused more examination, 1case of them underwent the operation of decoherence tumor and metastasis from common carotid artery and internal carotid artery, then used major pectoral muscle to protective carotid artery. 2 cases be suggested radiotherapy after underwent palliative surgery because more common carotid artery was be encroached. The rest 16 patients were evaluated with CTA.(2)The Results of CTA:3 cases nasopharyngeal carcinoma(NPC) encroached internal carotid artery of base of skull and 1 carcinoma of infra-pharynx with metastasis encroached common carotid artery were evaluated with DSA. 2 patients with cancer of larynx refused more examination, one patients underwent operation to dissect the tumor from common carotid artery because it was smooth and integrity, the other be suggested radiotherapy after underwent palliative surgery because the common carotid artery thinningz and not clear. 1 carcinoma of infra-pharynx with metastasis encroached right common carotid artery and thyrocervical trunk;2 cases of thyroid cancer and 1 case of stromal sarcoma in esophagus of cervical segments involved common carotid artery and internal carotid artery, but there are interspace bettwen the tumor and blood vessel;5 cases of carotid body tumor's(CBT) blood supply from external carotid artery and the internal carotid artery was integrity . 1 case of chordoblastoma in parapharyngeal space and the oppressed internal carotid artery and internal jugular vein was integrity.(3)The Results of Digital subtraction angiography (DSA),balloon test occlusion(BTO),carotid back pressure : 3 cases of nasopharyngeal carcinoma encroached internal carotid artery of base of skull complete preoperative evaluation with carotid back pressure were 77/59(66)mmHg, 62/44(50)mmHg,68/49(55)mmHg,then permanent occlusion was used at siphon part of internal carotid artery before resection of carotid artery without complication. 3 cases survived after have been followed up from 11 months to 2 years. 1 carcinoma of infra-pharynx with metastasis encroached common carotid artery occurrence objective of nervous system with carotid back pressure was 57/39(45)mmHg, the patient relieved after stopping evaluation but hemiparalysis after refusing treatment of thrombolysis.ConclusionsEnhanced CT and CTA were used in different head and neck neoplasms involving the carotid arteries. The evaluation of carotid artery is necessary when resection of carotid artery would be performed.