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Published on: January 18, 2018
The incidence of stroke post neck dissection surgery and perioperative management
Samyuktha Melachuri1, Manasa Melachuri2, Benita Vallapil1
1University of Pittsburgh Medical Center Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA.
Insights
Stroke following head and neck surgery is rare but serious. Careful management of patients with stroke risk factors is crucial to prevent complications after neck dissection.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Oncology
Background:
- Head and neck surgery involves major blood vessels, posing risks for serious complications like stroke.
- Cerebrovascular events are a significant concern in patients undergoing neck dissections.
Purpose of the Study:
- To investigate the incidence of stroke after neck dissection.
- To identify risk factors and outcomes for stroke in patients undergoing head and neck surgery.
Main Methods:
- Retrospective review of UPMC databases (2004-2020) for patients with neck dissections and stroke.
- Identification of patients experiencing stroke within 30 days of neck dissection.
Main Results:
- Out of 4,230 patients with neck dissections, 41 had a history of stroke, transient ischemic attack (TIA), or carotid artery stenosis (CAS).
- One patient with multiple risk factors experienced a stroke post-dissection due to malignancy-related hypercoagulability and vessel injury, but recovered after intervention.
Conclusions:
- The incidence of stroke after neck dissection is low.
- Patients with pre-existing stroke risk factors require meticulous management to mitigate potential adverse cerebrovascular outcomes.
Background:
Head and neck surgery encompasses major vessels, raising the concern of life-threatening complications such as stroke.
Methods:
Databases at UPMC were queried to identify patients with both neck dissections and stroke from January 1st, 2004, to October 1st, 2020. A retrospective chart review was performed to identify patients who experienced a stroke within 30 days of a neck dissection.
Results:
Search of a UPMC database for carotid artery stenosis (CAS), transient ischemic attack (TIA), and stroke identified 20,527 patients. After matching with the Head and Neck Tumor Registry patients, 41 of 4230 patients with a neck dissection also had a stroke, TIA, or CAS in their lifetime. One patient, with multiple risk factors, despite pre-operative precautions, had a stroke 2 days post neck dissection in the setting of carotid occlusion from hypercoagulability of malignancy and intraoperative vessel injury. The patient subsequently underwent a carotid thrombectomy and vein patch repair and has had no additional cerebrovascular accidents.
Conclusion:
Although the incidence of stroke post neck dissection is minimal, patients with multiple risk factors for stroke should be managed carefully to prevent deleterious outcomes.
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