Cranial/cervical nerve dysfunction after carotid endarterectomy.

PURPOSE: The purpose of this article is to review the results of patients who had cranial and cervical nerve dysfunction after undergoing carotid endarterectomy.

METHODS

The prospective study reviewed 183 consecutive carotid endarterectomies. Preoperative and postoperative cranial nerve assessments were accomplished on all patients. Neurologic evaluation included direct fiberoptic laryngoscopy. Patients found to be neurologically intact had no further follow-up. Patients with postoperative neuropraxia were entered into regular long-term follow-up to assess delayed recovery.

RESULTS

Twenty-six (14.2%) nerve injuries were identified in 21 patients. There were 14 recurrent laryngeal, 8 hypoglossal, 2 marginal mandibular, and 2 greater auricular nerve dysfunctions. Two patients were lost to follow-up. Eighteen (9.8%) nerve injuries were transient, whereas two (1.1%) were permanent. Four patients are currently undergoing extended follow-up to assess delayed recovery. Two patients with recurrent laryngeal nerve dysfunction were found to have prolonged full recovery intervals: 20 months and 50 months, respectively.

CONCLUSIONS

The incidence of focal neuropraxia after carotid endarterectomy is presented. Most injuries are transient. However, permanent injuries can lead to significant disability. Extended follow-up will identify the small subset of patients with delayed complete nerve recovery.