Management of the Internal Carotid Artery in Skull Base Tumor Surgery

Introduction: Treatment of the carotid artery has been the last step in dealing with skull base lesions. The following study reports the author's experience.

Materials and Methods: More than 350 cases of skull base tumors requiring carotid artery management have been operated on. In all the cases preoperative assessment was achieved through four-vessel angiography along with the manual cross-compression test. Intraoperative carotid artery treatment included: simple skeletonization, dislocation, resection after balloon occlusion, and intraluminal stent reinforcement.

Results: Gross total removal was possible in all the cases. Complications included a long-lasting hemiplegia produced by intimal dissection during catheter introduction, a defect in the visual field that partially resolved, and an intraoperative carotid artery rupture due to wrong positioning of the stent.

Conclusions: Different modalities of management of the internal carotid artery presently allow the surgeon to remove skull base lesions previously considered inoperable.