Carotid artery sacrifice testing: assessment in patients with advanced head and neck cancer

The otolaryngologist seeking a cure of the patient with advanced cancer of the head and neck removes all neck metastases along with the primary tumor. Tumor involvement of the carotid artery presents a special dilemma to the otolaryngologist because a complete resection would mean removal of the affected carotid artery, a procedure which has, historically, carried high morbidity and mortality rates. Today, the otolaryngologist will offer tumor resection with carotid artery sacrifice only after a patient passes a preoperative assessment of collateral circulation to the brain. Numerous methods have been devised to determine a patient's preoperative risk of neurologic compromise. Several tests are detailed and their usefulness discussed.