Background: Cranial nerve injury (CNI) is the most common neurological complication associated with carotid endarterectomy (CEA). Some authors postulate that the transverse skin incision leads to increased risk of CNI.
Objective: We compared the incidence of CNI associated with the transverse and longitudinal skin incisions in a high-volume cerebrovascular center.
Methods: We reviewed the charts of 226 consecutive patients who underwent CEAs between January 2007 and August 2009. Pre- and postoperative standardized neurological evaluations were performed by faculty neurologists and neurosurgeons.
Results: 169 of 226 (75%) CEAs were performed using a transverse incision. The longitudinal incision was generally reserved for patients with a high-riding carotid bifurcation. Mean patient age was 69 years (range, 45-91 years); 62% were males; 59% of patients were symptomatic, and 70% had high-grade stenosis (70%-99%). CNI occurred in 8 cases (3.5%): 5 (3%) in transverse and 3 (5.3%) with longitudinal incisions (p=0.42). There were 2 marginal mandibular nerve injuries, 1 (0.6%) transverse and 1 (1.7%) longitudinal; 5 recurrent laryngeal nerve injuries, 4 (2.3%) transverse and 1 (0.4%) longitudinal; and 1 case (0.5%) of hypoglossal nerve injury associated with longitudinal incision. One hematoma was associated with CNI. All injuries were transient. Fourteen wound hematomas required surgical evacuation (6.1%).
Conclusion: The transverse skin incision for CEAs is not associated with an increased risk of CNI (p =0.42). In this study, the incidence of CNI associated with the transverse incision was 3% (n=5) versus 5% (n=3) for longitudinal incisions. All CNI were temporary.
From: Carotid Endarterectomy: Comparison of Complications Between Transverse and Longitudinal Incision by Mendes et al.