Peripheral neurologic complications after carotid surgery

INTRODUCTION: In recent years, with development of carotid surgery and significant decrease of central neurological complications, more and more attention has been paid to the occurrence of peripheral neurological complications. Most frequent neurological lesions are as follows: auricularis magnus nerve, hypoglossal nerve, vagal nerve, inf. laryngeal nerve, sup. laryngeal nerve, glossopharyngeal nerve and spinal nerve. MATERIAL AND METHODS: In the period from May 1995 to January 1997, 97 patients underwent surgery because of carotid arteries lesions. Bilateral lesion of carotid arteries was treated in 27 patients. Standardized surgical procedures were performed while neurological examinations were performed postoperatively to check for possible peripheral neurological deficit. RESULTS: Cerebrovascular insult was the cause of death in one patient (1.2%). Transitory ischemic attack also occurred in one patient (1.2%). Peripheral nerve lesions were observed in 13 patients that is in 11.3% of cases; auricularis magnus nerve lesion in 9 patients (8.3%); sup. laryngeal nerve lesion in 3 patients (2.8%); mandibular branch of the facial nerve lesion in one patient (0.9%). DISCUSSION: The global incidence of postoperative peripheral neurological complications after carotid surgery was 11.3% cases, while according to the literature data it is from 10.5% to 13%. The most frequent are the lesions of auricularis magnus nerve and sup. laryngeal nerve. CONCLUSION: The incidence of peripheral neurological complications is higher than it is thought to be. Majority of these lesions are with transitory effect. Good knowledge of the precise surgical technique is a prerequisite to decrease the rate of these complications.