How are cranial nerve injuries caused by carotid endarterectomy (CEA) treated?

Updated: Oct 24, 2019
  • Author: Sonia Nhieu, MD; Chief Editor: Sheela Pai Cole, MD  more...
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Excessive retraction is the most common cause of CN injury; other, less common causes include the following:

  • Blunt trauma
  • Injury from forceps and arterial clamps
  • Damage from electrocauterization

The vagus nerve appears to be the CN most commonly injured during CEA, with a 3.99% incidence of injury and a 0.57% rate of permanent injury; the hypoglossal nerve is the next most commonly injured CN. [19]

It should be noted that the term permanent injury has variable meanings in this setting, given that different studies use different time frames. Some authors define a permanent deficit as one lasting longer than 12 months, whereas others consider a deficit permanent at 6 months. In addition, there have been reports of patients regaining function 3 years after a CN injury. [22]  Consequently, it is difficult at present to perform a true analysis of the incidence of permanent CN injury after CEA.

Data on the management of postoperative CN injuries are sparse. Prevention may be facilitated by thoroughly understanding the anatomy during surgical dissection so as to minimize traction and compression, as well as by using forceps, retractors, cautery, and arterial clamps with appropriate care. Perioperative dexamethasone also was shown to reduce the incidence of temporary CN injuries during CEAs; however, continued treatment in the presence of a CN injury had no effect on the incidence of permanent CN injuries. [23]

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