Postoperative carotid spasm in the setting of head and neck surgery

Delayed arterial spasm is a clinical and angiographic condition frequently observed after subarachnoid hemorrhage. It has long been associated with a local myogenic reaction to prolonged arterial contact with fresh blood. Carotid spasm from direct manipulation of the petrous carotid during skull base procedures is also a rare but known response to longitudinal arterial traction. Uncomplicated cervical cases, although subject to similar conditions of arterial manipulation, have less commonly been associated with arterial spasm. Two cases of severe internal carotid spasm leading to stroke in patients undergoing removal of glomus tumors are presented to emphasize carotid spasm as a potential complication in head and neck surgery. The perioperative guidelines to prevent, recognize, and treat this complication are also reviewed as outlined in the literature.