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

Clinical article

Full access

Object

Resection of 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. The authors therefore evaluated the outcomes of advanced skull base malignancies in patients who were treated with bypass and resection of the internal carotid artery (ICA).

Methods

The authors retrospectively reviewed the charts of all patients with advanced head and neck cancers who underwent ICA sacrifice with revascularization in which an extracranial-intracranial bypass was used between 1995 and 2010 at the Barrow Neurological Institute.

Results

Eighteen patients (11 male and 7 female patients; mean age 46 years, range 7–69 years) 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 of a stroke after revascularization. A second patient died of the effects of a fistula between the oral and cranial cavities (surgery-related mortality rate 11.1%). Eight months after the operation, 1 patient developed occlusion of the bypass and died. Complications associated with the bypass surgery included 1 case of subdural hematoma (SDH) with blindness, 1 case of status epilepticus, and 1 case of asymptomatic bypass occlusion (bypass-related morbidity 16.7%). Complications associated with tumor resection included 3 cases of CSF leakage requiring repair and shunting, 1 case of hydrocephalus requiring shunting, 1 case of SDH, and 1 case of contralateral ICA injury requiring a bypass (tumor resection morbidity rate 33.3%). In 1 patient treated with adjuvant therapy before surgery, the authors identified only a radiation effect and no tumor on resection. In a second patient the bypass was occluded, and her tumor was not resected. The other 16 patients underwent gross-total resection of their tumor. Excluding the surgery-related deaths, the mean and median lengths of survival in this series were 13.2 and 8.3 months, respectively (range 1.5–48 months). Including the surgery-related deaths, the mean and median lengths of survival were 11.8 and 8 months, respectively (range 17 days–48 months). At last follow-up all patients had died of cancer or cancer-related causes.

Conclusions

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.

Abbreviations used in this paper:CA = carotid artery; ICA = internal CA; MCA = middle cerebral artery; RAG = radial artery graft; SCC = squamous cell carcinoma; SDH = subdural hematoma; STA = superficial temporal artery; SVG = saphenous vein graft.

Abstract

Object

Resection of 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. The authors therefore evaluated the outcomes of advanced skull base malignancies in patients who were treated with bypass and resection of the internal carotid artery (ICA).

Methods

The authors retrospectively reviewed the charts of all patients with advanced head and neck cancers who underwent ICA sacrifice with revascularization in which an extracranial-intracranial bypass was used between 1995 and 2010 at the Barrow Neurological Institute.

Results

Eighteen patients (11 male and 7 female patients; mean age 46 years, range 7–69 years) 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 of a stroke after revascularization. A second patient died of the effects of a fistula between the oral and cranial cavities (surgery-related mortality rate 11.1%). Eight months after the operation, 1 patient developed occlusion of the bypass and died. Complications associated with the bypass surgery included 1 case of subdural hematoma (SDH) with blindness, 1 case of status epilepticus, and 1 case of asymptomatic bypass occlusion (bypass-related morbidity 16.7%). Complications associated with tumor resection included 3 cases of CSF leakage requiring repair and shunting, 1 case of hydrocephalus requiring shunting, 1 case of SDH, and 1 case of contralateral ICA injury requiring a bypass (tumor resection morbidity rate 33.3%). In 1 patient treated with adjuvant therapy before surgery, the authors identified only a radiation effect and no tumor on resection. In a second patient the bypass was occluded, and her tumor was not resected. The other 16 patients underwent gross-total resection of their tumor. Excluding the surgery-related deaths, the mean and median lengths of survival in this series were 13.2 and 8.3 months, respectively (range 1.5–48 months). Including the surgery-related deaths, the mean and median lengths of survival were 11.8 and 8 months, respectively (range 17 days–48 months). At last follow-up all patients had died of cancer or cancer-related causes.

Conclusions

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.

Head and neck cancers involving the CA at the skull base usually have a poor prognosis because they are frequently diagnosed at advanced stages, and their recurrence rate is high even after surgery or chemoradiotherapy.2,8 The optimal management for advanced head and neck cancers remains resection to microscopically negative (“clean”) margins, coupled with adjuvant therapy. Tumors are considered operable if negative margins can be obtained safely.

These tumors may arise from the bony skull base itself or from the intracranial compartment and may secondarily involve the skull base. However, they typically arise from soft tissues, respiratory or digestive tracts, and skin.20,26,35 Growing tumors may involve the CA at the neck or the skull base, thereby increasing the challenge of treatment. The decision to intervene in cases of CA involvement depends on tumor type, tumor location, and systemic disease status.40 Treatment options for advanced head and neck cancers involving the CA include hospice care, nonsurgical adjuvant therapy, CA peeling, and CA resection with or without revascularization.6,16,17,24

The risks of stroke and death involved with sacrificing the CA are significant.22,23,37 To decrease the overall morbidity and mortality rates associated with CA sacrifice, revascularization may be performed. Related complications, such as bypass rupture and occlusion,12,23,41 and the inability of existing tests to predict cerebral vascular reserve,10,25,29 pose further challenges to this strategy.

When cancers involve the CA in the neck, carotid sacrifice improves the 2-year survival rate but is associated with a significant risk of neurological deficits, stroke, and delayed ischemic complications.1,3,5,21,28,41 The perioperative mortality rate ranges from 0% to 45%, and the rate of de novo aneurysm formation ranges from 1% to 10%.1,3,5,21,28,41 Involvement of the ICA at the skull base (cavernous sinus, petrous, or infratemporal segments) has been considered a contraindication for resection.36 However, some surgeons have argued that there may still be a role for such an approach.6,16,28 To evaluate this possibility we analyzed our approach, which consisted of bypass and resection for treatment of CA involvement with tumors at the skull base.

Methods

We retrospectively reviewed the charts of all patients with recurrent or progressive advanced head and neck cancers involving the ICA at the skull base who underwent ICA sacrifice with revascularization in which an extracranial-intracranial bypass was used between 1995 and 2010 at the Barrow Neurological Institute. Follow-up was based on telephone calls to patients, families, and primary care physicians, as well as on our office records. Patient hospital and office records were evaluated retrospectively.

Altogether, 18 patients (11 male and 7 female patients; mean age 46 years, range 7–69 years [Table 1]) with recurrent or progressive malignancies involving the ICA at the level of infratemporal fossa, petrous bone, or cavernous sinus were treated (Fig. 1). Nine of these patients have been reported in other studies from our group. 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

TABLE 1:

Clinical summary of 18 patients who underwent bypass for skull base carcinomas*

Case No.Age (yrs), SexInvolved Segment of ICABypass TypeComplicationsPathological FindingFU (mos)Adjuvant Therapies
BypassTumor Resection
156, Mpetrousregular w/ SVGSDH, blindnessnonenasopharyngeal cancer8.5chemo + XRT
266, Fcavernousregular w/ SVGnoneCSF leakcutaneous SCC8.0XRT
317, Fcavernousregular w/ SVGnonenoneosteosarcoma10.0chemo + XRT
457, Minfratemporalbonnet w/ RAGnonenonepalatal SCC9.0chemo + XRT
535, Minfratemporalbonnet w/ RAGnonenonelaryngeal SCC4.0chemo + XRT
635, Mcavernousbonnet w/ RAGnonepneumocephalus secondary to fistula btwn cranial & oral cavitiesunclassified sarcoma17 days (died)none
77, Fcavernousregular w/ SVGnonenonerhabdomyosarcoma2.0chemo + XRT
835, Fcavernousregular w/ SVGnonehydrocephalusadenocystic cancer20.0chemo + XRT
966, Mcavernousregular w/ RAGnonenonesinonasal SCC1.5XRT
1047, Fpetrousregular w/ SVGnonenonepalatal SCC40.0XRT
1152, Minfratemporalbonnet w/ SVGnoneCSF leakcutaneous SCC2.0XRT
1269, Minfratemporalbonnet w/ SVGstrokenonepalatal SCC1.0XRT
1358, Minfratemporalbonnet w/ RAGnonenoneSCC of tongue8.0XRT
1446, Minfratemporalbonnet w/ RAGnoneCSF leakmedullary thyroid cancer7.0XRT
1557, Fpetrousbonnet w/ RAGnoneSDH, status epilepticus, no tumor (scar) found at oprhabdomyosarcoma23.0chemo + XRT
1654, Minfratemporalbonnet w/ RAGnonenonesinonasal cancer1.5XRT
1732, Minfratemporalregular w/ SVGnonerupture of contralat ICA requiring bypassadenocystic cancer48.0NA
1839, Finfratemporalbonnet w/ SVGbypass occlusionnoneadenocystic cancer18.0NA

* chemo = chemotherapy; FU = follow-up; NA = not available; XRT = radiation therapy.

† Died of a stroke 10 months after surgery.

Fig. 1.
Fig. 1.

Case 2. Imaging studies obtained in a 66-year-old woman. Axial T1-weighted MRI studies without (A) and with (B) contrast demonstrating a recurrent SCC on the left side encasing the cavernous ICA with extension into the orbit. The lesion infiltrates the left ICA and cavernous sinus (arrow). Note the absence of flow void in the left cavernous ICA. These images were obtained after clip occlusion of the left ICA in the neck and supraclinoid region. C: Angiogram demonstrating the ICA-MCA with saphenous vein bypass before the tumor was resected. D: Axial T1-weighted MR image obtained after tumor resection. The skull base has been reconstructed with free tissue transfer by using a rectus abdominus muscle flap. Reprinted with permission from Feiz-Erfan et al.: Neurosurg Focus 14(3):e6, 2003.

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. All patients underwent an extracranial-intracranial bypass, which included a direct ipsilateral bypass with a SVG32–34 in 7 cases, a RAG in 1 case, a so-called bonnet bypass (STA to contralateral MCA) with a SVG in 3 patients,9,38 and a bonnet bypass with a RAG in 7 cases (Figs. 2 and 3). Revascularization was performed after mild hypothermia was established and barbiturate protection was provided. Electroencephalographic monitoring was conducted intraoperatively. The tumor was resected in a second-stage procedure. Postoperatively, all patients were maintained on aspirin (325 mg) for life.

Fig. 2.
Fig. 2.

Illustration of a bonnet bypass in a case of tumor involving the CA in the infratemporal fossa. Used with permission from Barrow Neurological Institute.

Fig. 3.
Fig. 3.

Angiogram demonstrating a patent bonnet bypass.

Results

Table 2 summarizes the outcomes of the patients. Immediately after surgery (within the first 24 hours) the bypass was functional and patent in all 18 patients (immediate patency rate 100%), but 1 bypass failed (overall patency rate 94.4%) in the postoperative period. Three complications (16.7%) were associated with the bypass surgery: 1 SDH associated with blindness (Case 1), 1 stroke (Case 12), and 1 asymptomatic bypass occlusion (Case 18). The patient with the stroke (Case 12) died within the postoperative period. At surgery another patient (Case 15) was found to have radiation effect instead of tumor; consequently, this patient unnecessarily underwent ICA sacrifice and bypass.

TABLE 2:

Summary of characteristics and outcomes in patients with advanced head and neck cancers that involved the CA

CharacteristicValue (%)
no. of patients18
pathological findings
 sarcoma4
 carcinoma14
types of bypass
 regular w/ RAG1 (5)
 regular w/ SVG7 (39)
 bonnet w/ RAG7 (39)
 bonnet w/ SVG3 (17)
patent bypass17 of 18 (94.4)
morbidity from bypass2 (11.1)
morbidity from tumor resection6 (33.3)
surgery-related mortality2 (11.1)
1-yr survival rate5 (27.8)
2-yr survival rate2 (11.1)
mean survival11.8 mos
median survival8 mos
range survival17 days–48 mos

The tumors were resected in the remaining 16 patients (88.9%). Six complications (33.3%) were associated with the resection of tumors: 3 cases of CSF leakage (16.7%—Cases 2, 11, and 14); 1 case each of hydrocephalus (Case 8) and iatrogenic vascular injury to the contralateral ICA (Case 17); and the patient who was found to have radiation effect at surgery (Case 15) suffered an SDH related to anticoagulation therapy and had status epilepticus.

Two patients died (surgery-related mortality rate 11.1%). Besides the patient who had a stroke from occlusion of the bypass, a second patient (Case 6) died of infection and pneumocephalus related to a fistula between his oral and cranial cavities.

Histological evaluation of the ICA for tumor invasion was available in 7 cases. In a single case, histological examination of the specimen confirmed invasion of the ICA wall by tumor (Fig. 4). Histologically, except in the case of treatment effect, all resected specimens were confirmed to be malignancies.

Fig. 4.
Fig. 4.

Photomicrographs of tumor sections demonstrating invasion of the CA wall by tumor cells (left) and cellular nests within the adventitia (right). H & E, original magnification ×40 (left) and ×100 (right).

The interval between revascularization and tumor resection ranged from 1 to 37 days (mean 9.1 days, median 7 days). The length of hospitalization ranged from 13 to 43 days (mean 22, median 20 days). Eight patients (44.4%) were discharged to home, 2 (11.1%) to rehabilitation, and 3 (16.7%) to a skilled nursing facility. Data were unavailable for 3 patients (16.7%).

All patients died of progression of their disease, but no information was available on local versus distant recurrence of disease in most cases. The overall mean and median follow-up (excluding the surgery-related deaths) was 13.2 and 8.3 months, respectively (range 1.5–48 months). Including the surgery-related deaths, the mean and median follow-up of patients was 11.8 and 8 months, respectively (range 17 days–48 months).

Five patients survived longer than 12 months (overall 1-year survival rate 27.8%). Of these patients, 1 had a palatal SCC, 1 had a rhabdomyosarcoma (in which the final pathological finding was consistent with treatment effect), and 3 had an adenocystic carcinoma. Only 2 patients survived longer than 24 months (overall 2-year survival rate 11.1%). One of them had a palatal SCC, and the second had an adenocystic carcinoma. Based on subgroup analysis, patients with adenocystic cancers survived an average of 28.7 months (range 18–48, median 20 months), whereas those with nonadenocystic cancers (excluding the patient with the treatment effect and no viable cancer) survived an average of 7.4 months (range 17 days–23 months, median 5.5 months).

Discussion

Three collaborative international studies have established the morbidity, mortality, and median survival rates for patients with skull base malignancies following craniofacial resections.13–15 Surgical complications were noted in one-quarter to one-third of patients with skull base malignancies (range 25%–36.3%), and their rate of postoperative mortality ranged from 1.4% to 4.8%. These studies reported 5-year overall and recurrence-free survival rates of 61%–62% and of 55%–57%, respectively.13–15 In separate studies of patients undergoing infratemporal resections of skull base malignancies, complications occurred in 28%–31% of cases, with a 4% mortality rate.4,20 Our morbidity and mortality rates were 33.3% and 11.1%, respectively. The median survival rate in our series was 8 months. Although our morbidity rate is within the published range, our mortality and survival rates are worse than those reported by others.13–15

Sacrifice of the CA in the neck has been associated with better results than sacrifice of that vessel in the skull base.3,5,21,28 Malignancies that extensively involve the skull base or that extend into the cavernous sinus, pituitary gland, or orbit are usually contraindications for surgical intervention.36 Several studies have challenged this view and suggested that there may be an indication to pursue aggressive tumor resection and CA sacrifice with concomitant revascularization.6,16,28 Gormley et al.16 focused on adenocystic carcinomas with an intracranial extension. Of 16 such patients who underwent bypass and carotid resection at the skull base, 8 died (mean follow-up 137 months, range 33–216 months) and 6 were alive without evidence of local disease (mean follow-up 72 months, range 25–204 months). One patient had evidence of local disease but was still alive 56 months after surgery, and 1 died of complications associated with the procedure at 63 months. Brisman et al.6 evaluated 7 patients who underwent revascularization and aggressive resection of tumors and CA at the skull base. Four patients were alive in good condition, 1 died 2.5 years after surgery without evidence of local recurrence, and 2 experienced vascular occlusion of their bypass with 1 major stroke. Nayak et al.28 described 6 patients who underwent revascularization and carotid sacrifice at the skull base. None of these patients survived beyond 2 years, but 2 survived 9 and 12 months after surgery, respectively, and a third survived 14 months before dying.

The argument that CA sacrifice and bypass may improve survival for patients with malignancies at the skull base may be specific to the histological type of the cancer. In our series the 1- and 2-year survival rates were 27.8% and 11.1%, respectively. Of the 5 patients who survived beyond 1 year, 3 had adenocystic carcinomas, 1 had a rhabdomyosarcoma (which intraoperatively was noted to be scar tissue and not tumor), and 1 had an SCC. A prior study had highlighted the improved outcome of patients with adenocystic cancers after carotid resection and revascularization.16 We also noted that patients with this type of tumor survived longer after aggressive resection and bypass compared with patients with nonadenocystic tumors.

The actual ability of tumor to invade the CA has been debated. In some case reports of microscopically evaluated cancer-invaded cavernous sinus, no invasion of the ICA by the tumor was found—only encasement of the artery.7,27 One of our patients had pathologically proven invasion of the vessel by tumor. Although physical vascular invasion may be rare, extensive encasement without malignant invasion of the vessel wall would still require sacrifice of the ICA to attempt to achieve microscopically negative margins. Due to the paucity of data, we could not demonstrate that resection of the ICA at the skull base for malignancies allowed us to achieve a microscopically negative margin.

With high rates of morbidity and mortality, poor postresection survival rates, and improved survival with chemoradiotherapy,30,31 the role of aggressive resection has been questioned.19 In some series of skull base tumors treated with adjuvant therapies, overall survival rates at 2 and 3 years have been reported at 80% and 36%, respectively.18,19 Our data indicate that despite resection, the presence of ICA involvement in advanced head and neck cancers portends a worse prognosis, with higher morbidity and mortality rates, compared with patients without ICA involvement. Given this trend toward poor outcomes, the futility of this procedure outweighs its benefits in most cases. It should be used with caution and only after careful patient selection.

Conclusions

The ideal treatment regimen for malignant tumors involving the CA at the skull base remains nonsurgical. On certain occasions, carotid sacrifice and bypass may have a role in the treatment of tumors with less aggressive biological behaviors, such as adenocystic carcinomas. Given the high rates of surgery-related mortality and poor survival despite aggressive measures, we interpret our results and those of other authors as indicating that in cases of aggressive malignancies, CA involvement at the skull base is a relative contraindication to revascularization and aggressive resection.

Disclosure

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Author contributions to the study and manuscript preparation include the following. Acquisition of data: Kalani, Kalb, Martirosyan. Analysis and interpretation of data: Feiz-Erfan, Kalani. Drafting the article: Kalani. Critically revising the article: Feiz-Erfan, Kalani. Reviewed submitted version of manuscript: all authors. Statistical analysis: Kalb. Administrative/technical/material support: Kalb, Martirosyan. Study supervision: Feiz-Erfan, Spetzler, Porter.

This article contains some figures that are displayed in color online but in black-and-white in the print edition.

References

  • 1

    Atkinson DPJacobs LAWeaver AW: Elective carotid resection for squamous cell carcinoma of the head and neck. Am J Surg 148:4834881984

  • 2

    Bernier JDomenge COzsahin MMatuszewska KLefèbvre JLGreiner RH: Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350:194519522004

  • 3

    Biller HFUrken MLawson WHaimov M: Carotid artery resection and bypass for neck carcinoma. Laryngoscope 98:1811831988

  • 4

    Bilsky MHBentz BVitaz TShah JKraus D: Craniofacial resection for cranial base malignancies involving the infratemporal fossa. Neurosurgery 57:4 Suppl3393472005

  • 5

    Brennan JAJafek BW: Elective carotid artery resection for advanced squamous cell carcinoma of the neck. Laryngoscope 104:2592631994

  • 6

    Brisman MHSen CCatalano P: Results of surgery for head and neck tumors that involve the carotid artery at the skull base. J Neurosurg 86:7877921997

  • 7

    Bumpous JMMaves MDGomez SMLevy BKJohnson F: Cavernous sinus involvement in head and neck cancer. Head Neck 15:62661993

  • 8

    Cooper JSPajak TFForastiere AAJacobs JCampbell BHSaxman SB: Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 350:193719442004

  • 9

    Deshmukh VRPorter RWSpetzler RF: Use of “bonnet” bypass with radial artery interposition graft in a patient with recurrent cranial base carcinoma: technical report of two cases and review of the literature. Neurosurgery 56:1 SupplE2022005

  • 10

    Drake CGPeerless SJFerguson GG: Hunterian proximal arterial occlusion for giant aneurysms of the carotid circulation. J Neurosurg 81:6566651994

  • 11

    Feiz-Erfan IHan PPSpetzler RFLanzino GFerreira MAGonzalez LF: Salvage of advanced squamous cell carcinomas of the head and neck: internal carotid artery sacrifice and extracranial-intracranial revascularization. Neurosurg Focus 14:3e62003

  • 12

    Freeman SBHamaker RCBorrowdale RBHuntley TC: Management of neck metastasis with carotid artery involvement. Laryngoscope 114:20242004

  • 13

    Ganly IPatel SGSingh BKraus DHBridger PGCantu G: Complications of craniofacial resection for malignant tumors of the skull base: report of an International Collaborative Study. Head Neck 27:4454512005

  • 14

    Gil ZPatel SGCantu GFliss DMKowalski LPSingh B: Outcome of craniofacial surgery in children and adolescents with malignant tumors involving the skull base: an international collaborative study. Head Neck 31:3083172009

  • 15

    Gil ZPatel SGSingh BCantu GFliss DMKowalski LP: Analysis of prognostic factors in 146 patients with anterior skull base sarcoma: an international collaborative study. Cancer 110:103310412007

  • 16

    Gormley WBSekhar LNWright DCOlding MJanecka IPSnyderman CH: Management and long-term outcome of adenoid cystic carcinoma with intracranial extension: a neurosurgical perspective. Neurosurgery 38:110511131996

  • 17

    Graham MDSataloff RTKemink JLWolf GTMcGillicuddy JE: Total en bloc resection of the temporal bone and carotid artery for malignant tumors of the ear and temporal bone. Laryngoscope 94:5285331984

  • 18

    Harrison LBPfister DGKraus DArmstrong JGZelefsky MJWiseberg J: Management of unresectable malignant tumors at the skull base using concomitant chemotherapy and radiotherapy with accelerated fractionation. Skull Base Surg 4:1271311994

  • 19

    Harrison LBRaben APfister DGZelefsky MStrong EShah JP: A prospective phase II trial of concomitant chemotherapy and radiotherapy with delayed accelerated fractionation in unresectable tumors of the head and neck. Head Neck 20:4975031998

  • 20

    Hentschel SJVora YSuki DHanna EYDeMonte F: Malignant tumors of the anterolateral skull base. Neurosurgery 66:1021122010

  • 21

    Iván LPaczona RCzigner J: Carotid artery resection and reconstruction in patients with squamous cell carcinomas of the neck. Eur Arch Otorhinolaryngol 256:1451471999

  • 22

    Katsuno STakemae TIshiyama TUsami SI: Is carotid reconstruction for advanced cancer in the neck a safe procedure?. Otolaryngol Head Neck Surg 124:2222242001

  • 23

    Konno ATogawa KIizuka K: Analysis of factors affecting complications of carotid ligation. Ann Otol Rhinol Laryngol 90:2222261981

  • 24

    Lawton MTSpetzler RF: Internal carotid artery sacrifice for radical resection of skull base tumors. Skull Base Surg 6:1191231996

  • 25

    Linskey MEJungreis CAYonas HHirsch WL JrSekhar LNHorton JA: Stroke risk after abrupt internal carotid artery sacrifice: accuracy of preoperative assessment with balloon test occlusion and stable xenon-enhanced CT. AJNR Am J Neuroradiol 15:8298431994

  • 26

    Manolidis SPappas D JrVon Doersten PJackson CGGlasscock ME III: Temporal bone and lateral skull base malignancy: experience and results with 81 patients. Am J Otol 19:6 SupplS1S151998

  • 27

    Mills RPInsalaco SJJoseph A: Bilateral cavernous sinus metastasis and ophthalmoplegia. Case report. J Neurosurg 55:4634661981

  • 28

    Nayak UKDonald PJStevens D: Internal carotid artery resection for invasion of malignant tumors. Arch Otolaryngol Head Neck Surg 121:102910331995

  • 29

    Origitano TCal-Mefty OLeonetti JPDeMonte FReichman OH: Vascular considerations and complications in cranial base surgery. Neurosurgery 35:3513631994

  • 30

    Robbins KTSamant SVieira FKumar P: Presurgical cytoreduction of oral cancer using intra-arterial cisplatin and limited concomitant radiation therapy (Neo-RADPLAT). Arch Otolaryngol Head Neck Surg 130:28322004

  • 31

    Samant SRobbins KTVang MWan JRobertson J: Intraarterial cisplatin and concomitant radiation therapy followed by surgery for advanced paranasal sinus cancer. Arch Otolaryngol Head Neck Surg 130:9489552004

  • 32

    Sekhar LNBucur SDBank WOWright DC: Venous and arterial bypass grafts for difficult tumors, aneurysms, and occlusive vascular lesions: evolution of surgical treatment and improved graft results. Neurosurgery 44:120712241999

  • 33

    Sekhar LNNatarajan SKEllenbogen RGGhodke B: Cerebral revascularization for ischemia, aneurysms, and cranial base tumors. Neurosurgery 62:6 Suppl 3137314102008

  • 34

    Sekhar LNSen CNJho HD: Saphenous vein graft bypass of the cavernous internal carotid artery. J Neurosurg 72:35411990

  • 35

    Sen CTriana AHiltzik DCostantino PLawson WUrken M: Malignant tumors involving the lateral skull base. Clin Neurosurg 48:3733862001

  • 36

    Shah JPKraus DHBilsky MHGutin PHHarrison LHStrong EW: Craniofacial resection for malignant tumors involving the anterior skull base. Arch Otolaryngol Head Neck Surg 123:131213171997

  • 37

    Snyderman CHD'Amico F: Outcome of carotid artery resection for neoplastic disease: a meta-analysis. Am J Otolaryngol 13:3733801992

  • 38

    Spetzler RFRoski RARhodes RSModic MT: The “bonnet bypass. Case report. J Neurosurg 53:7077091980

  • 39

    Vishteh AGNadkarni TDSpetzler RF: Resection of adenoid cystic carcinomas of the skull base: experience with five patients. BNI Q 16:18232000

  • 40

    Wolfe SQTummala RPMorcos JJ: Cerebral revascularization in skull base tumors. Skull Base 15:71822005

  • 41

    Wright JGNicholson RSchuller DESmead WL: Resection of the internal carotid artery and replacement with greater saphenous vein: a safe procedure for en bloc cancer resections with carotid involvement. J Vasc Surg 23:7757821996

Article Information

Address correspondence to: Iman Feiz-Erfan, M.D., c/o Neuroscience Publications, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 West Thomas Road, Phoenix, Arizona 85013. email: Neuropub@dignityhealth.org.

Please include this information when citing this paper: published online October 19, 2012; DOI: 10.3171/2012.9.JNS12332.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Case 2. Imaging studies obtained in a 66-year-old woman. Axial T1-weighted MRI studies without (A) and with (B) contrast demonstrating a recurrent SCC on the left side encasing the cavernous ICA with extension into the orbit. The lesion infiltrates the left ICA and cavernous sinus (arrow). Note the absence of flow void in the left cavernous ICA. These images were obtained after clip occlusion of the left ICA in the neck and supraclinoid region. C: Angiogram demonstrating the ICA-MCA with saphenous vein bypass before the tumor was resected. D: Axial T1-weighted MR image obtained after tumor resection. The skull base has been reconstructed with free tissue transfer by using a rectus abdominus muscle flap. Reprinted with permission from Feiz-Erfan et al.: Neurosurg Focus 14(3):e6, 2003.

  • View in gallery

    Illustration of a bonnet bypass in a case of tumor involving the CA in the infratemporal fossa. Used with permission from Barrow Neurological Institute.

  • View in gallery

    Angiogram demonstrating a patent bonnet bypass.

  • View in gallery

    Photomicrographs of tumor sections demonstrating invasion of the CA wall by tumor cells (left) and cellular nests within the adventitia (right). H & E, original magnification ×40 (left) and ×100 (right).

References

1

Atkinson DPJacobs LAWeaver AW: Elective carotid resection for squamous cell carcinoma of the head and neck. Am J Surg 148:4834881984

2

Bernier JDomenge COzsahin MMatuszewska KLefèbvre JLGreiner RH: Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350:194519522004

3

Biller HFUrken MLawson WHaimov M: Carotid artery resection and bypass for neck carcinoma. Laryngoscope 98:1811831988

4

Bilsky MHBentz BVitaz TShah JKraus D: Craniofacial resection for cranial base malignancies involving the infratemporal fossa. Neurosurgery 57:4 Suppl3393472005

5

Brennan JAJafek BW: Elective carotid artery resection for advanced squamous cell carcinoma of the neck. Laryngoscope 104:2592631994

6

Brisman MHSen CCatalano P: Results of surgery for head and neck tumors that involve the carotid artery at the skull base. J Neurosurg 86:7877921997

7

Bumpous JMMaves MDGomez SMLevy BKJohnson F: Cavernous sinus involvement in head and neck cancer. Head Neck 15:62661993

8

Cooper JSPajak TFForastiere AAJacobs JCampbell BHSaxman SB: Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 350:193719442004

9

Deshmukh VRPorter RWSpetzler RF: Use of “bonnet” bypass with radial artery interposition graft in a patient with recurrent cranial base carcinoma: technical report of two cases and review of the literature. Neurosurgery 56:1 SupplE2022005

10

Drake CGPeerless SJFerguson GG: Hunterian proximal arterial occlusion for giant aneurysms of the carotid circulation. J Neurosurg 81:6566651994

11

Feiz-Erfan IHan PPSpetzler RFLanzino GFerreira MAGonzalez LF: Salvage of advanced squamous cell carcinomas of the head and neck: internal carotid artery sacrifice and extracranial-intracranial revascularization. Neurosurg Focus 14:3e62003

12

Freeman SBHamaker RCBorrowdale RBHuntley TC: Management of neck metastasis with carotid artery involvement. Laryngoscope 114:20242004

13

Ganly IPatel SGSingh BKraus DHBridger PGCantu G: Complications of craniofacial resection for malignant tumors of the skull base: report of an International Collaborative Study. Head Neck 27:4454512005

14

Gil ZPatel SGCantu GFliss DMKowalski LPSingh B: Outcome of craniofacial surgery in children and adolescents with malignant tumors involving the skull base: an international collaborative study. Head Neck 31:3083172009

15

Gil ZPatel SGSingh BCantu GFliss DMKowalski LP: Analysis of prognostic factors in 146 patients with anterior skull base sarcoma: an international collaborative study. Cancer 110:103310412007

16

Gormley WBSekhar LNWright DCOlding MJanecka IPSnyderman CH: Management and long-term outcome of adenoid cystic carcinoma with intracranial extension: a neurosurgical perspective. Neurosurgery 38:110511131996

17

Graham MDSataloff RTKemink JLWolf GTMcGillicuddy JE: Total en bloc resection of the temporal bone and carotid artery for malignant tumors of the ear and temporal bone. Laryngoscope 94:5285331984

18

Harrison LBPfister DGKraus DArmstrong JGZelefsky MJWiseberg J: Management of unresectable malignant tumors at the skull base using concomitant chemotherapy and radiotherapy with accelerated fractionation. Skull Base Surg 4:1271311994

19

Harrison LBRaben APfister DGZelefsky MStrong EShah JP: A prospective phase II trial of concomitant chemotherapy and radiotherapy with delayed accelerated fractionation in unresectable tumors of the head and neck. Head Neck 20:4975031998

20

Hentschel SJVora YSuki DHanna EYDeMonte F: Malignant tumors of the anterolateral skull base. Neurosurgery 66:1021122010

21

Iván LPaczona RCzigner J: Carotid artery resection and reconstruction in patients with squamous cell carcinomas of the neck. Eur Arch Otorhinolaryngol 256:1451471999

22

Katsuno STakemae TIshiyama TUsami SI: Is carotid reconstruction for advanced cancer in the neck a safe procedure?. Otolaryngol Head Neck Surg 124:2222242001

23

Konno ATogawa KIizuka K: Analysis of factors affecting complications of carotid ligation. Ann Otol Rhinol Laryngol 90:2222261981

24

Lawton MTSpetzler RF: Internal carotid artery sacrifice for radical resection of skull base tumors. Skull Base Surg 6:1191231996

25

Linskey MEJungreis CAYonas HHirsch WL JrSekhar LNHorton JA: Stroke risk after abrupt internal carotid artery sacrifice: accuracy of preoperative assessment with balloon test occlusion and stable xenon-enhanced CT. AJNR Am J Neuroradiol 15:8298431994

26

Manolidis SPappas D JrVon Doersten PJackson CGGlasscock ME III: Temporal bone and lateral skull base malignancy: experience and results with 81 patients. Am J Otol 19:6 SupplS1S151998

27

Mills RPInsalaco SJJoseph A: Bilateral cavernous sinus metastasis and ophthalmoplegia. Case report. J Neurosurg 55:4634661981

28

Nayak UKDonald PJStevens D: Internal carotid artery resection for invasion of malignant tumors. Arch Otolaryngol Head Neck Surg 121:102910331995

29

Origitano TCal-Mefty OLeonetti JPDeMonte FReichman OH: Vascular considerations and complications in cranial base surgery. Neurosurgery 35:3513631994

30

Robbins KTSamant SVieira FKumar P: Presurgical cytoreduction of oral cancer using intra-arterial cisplatin and limited concomitant radiation therapy (Neo-RADPLAT). Arch Otolaryngol Head Neck Surg 130:28322004

31

Samant SRobbins KTVang MWan JRobertson J: Intraarterial cisplatin and concomitant radiation therapy followed by surgery for advanced paranasal sinus cancer. Arch Otolaryngol Head Neck Surg 130:9489552004

32

Sekhar LNBucur SDBank WOWright DC: Venous and arterial bypass grafts for difficult tumors, aneurysms, and occlusive vascular lesions: evolution of surgical treatment and improved graft results. Neurosurgery 44:120712241999

33

Sekhar LNNatarajan SKEllenbogen RGGhodke B: Cerebral revascularization for ischemia, aneurysms, and cranial base tumors. Neurosurgery 62:6 Suppl 3137314102008

34

Sekhar LNSen CNJho HD: Saphenous vein graft bypass of the cavernous internal carotid artery. J Neurosurg 72:35411990

35

Sen CTriana AHiltzik DCostantino PLawson WUrken M: Malignant tumors involving the lateral skull base. Clin Neurosurg 48:3733862001

36

Shah JPKraus DHBilsky MHGutin PHHarrison LHStrong EW: Craniofacial resection for malignant tumors involving the anterior skull base. Arch Otolaryngol Head Neck Surg 123:131213171997

37

Snyderman CHD'Amico F: Outcome of carotid artery resection for neoplastic disease: a meta-analysis. Am J Otolaryngol 13:3733801992

38

Spetzler RFRoski RARhodes RSModic MT: The “bonnet bypass. Case report. J Neurosurg 53:7077091980

39

Vishteh AGNadkarni TDSpetzler RF: Resection of adenoid cystic carcinomas of the skull base: experience with five patients. BNI Q 16:18232000

40

Wolfe SQTummala RPMorcos JJ: Cerebral revascularization in skull base tumors. Skull Base 15:71822005

41

Wright JGNicholson RSchuller DESmead WL: Resection of the internal carotid artery and replacement with greater saphenous vein: a safe procedure for en bloc cancer resections with carotid involvement. J Vasc Surg 23:7757821996

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 6 6 6
Full Text Views 96 96 39
PDF Downloads 77 77 50
EPUB Downloads 0 0 0

PubMed

Google Scholar