Internal carotid artery resection for invasion of malignant tumors

To study the preoperative investigation and outcome of patients who underwent resection of the internal carotid artery for malignant disease. A retrospective analysis using a chart review of these patients was performed, and the results were analyzed. All patients were treated by one of us (U.K.N.) at the University of California-Davis Medical Center, Sacramento. A population of 18 patients who underwent a transcervical, transpetrosal, or petrocavernous resection of the internal carotid artery from 1976 to 1993 was studied. Preoperative study consisted of four-vessel arteriography, balloon test occlusion, electroencephalographic intraoperative monitoring, and, after 1990, single-photon emission computed tomographic scanning. Disease-free interval and neurologic complications were assessed.

Two patients were alive and well without disease at 6 and 9 months postoperatively. One patient was alive and well at 12 months, and three have survived more than 2 years without recurrent tumor. Eleven patients died within 1 year of surgery (three postoperatively, six of recurrent disease, and two of unknown causes). One patient died of disease at 14 months.

Internal carotid artery invasion by malignancy portends a poor prognosis. Carotid artery resection can provide reasonable palliation. Early results of skull-base surgery on patients with intrapetrous and petrocavernous carotid artery involvement are encouraging. Balloon test occlusion and single-photon emission computed tomographic scanning provide a valuable assessment of contralateral cerebral blood flow.