Cunningham Edwin J, Bond Rick, Mayberg Marc R, Warlow Charles P, Rothwell Peter M
Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
J Neurosurg. 2004 Sep;101(3):445-8. doi: 10.3171/jns.2004.101.3.0445.
Cranial nerve injuries, particularly motor nerve injuries, following carotid endarterectomy (CEA) can be disabling and therefore patients should be given reliable information about the risks of sustaining such injuries. The reported frequency of cranial nerve injury in the published literature ranges from 3 to 23%, and there have been few series in which patients were routinely examined before and after surgery by a neurologist.
The authors investigated the risk of cranial nerve injuries in patients who underwent CEA in the European Carotid Surgery Trial (ECST), the largest series of patients undergoing CEA in which neurological assessment was performed before and after surgery. Cranial nerve injury was assessed and recorded in every patient and persisting deficits were identified on follow-up examination at 4 months and 1 year after randomization. Risk factors for cranial nerve injury were examined by performing univariate and multivariate analyses. There were 88 motor cranial nerve injuries among the 1739 patients undergoing CEA (5.1% of patients; 95% confidence interval [CI] 4.1-6.2). In 23 patients, the deficit had resolved by hospital discharge, leaving 3.7% of patients (95% CI 2.9-4.7) with a residual cranial nerve injury: 27 hypoglossal, 17 marginal mandibular, 17 recurrent laryngeal, one accessory nerve, and three Homer syndrome. In only nine patients (0.5%; 95% CI 0.24-0.98) the deficit was still present at the 4-month follow-up examination; however, none of the persisting deficits resolved during the subsequent follow up. Only duration of operation longer than 2 hours was independently associated with an increased risk of cranial nerve injury (hazard ratio 1.56, p < 0.0001).
The risk of motor cranial nerve injury persisting beyond hospital discharge after CEA is approximately 4%. The vast majority of neurological deficits resolve over the next few months, however, and permanent deficits are rare. Nevertheless, the risk of cranial nerve injury should be communicated to patients before they undergo surgery.
颈动脉内膜切除术（CEA）后发生的颅神经损伤，尤其是运动神经损伤，可能会导致残疾，因此应向患者提供有关此类损伤风险的可靠信息。已发表文献中报道的颅神经损伤发生率在3%至23%之间，很少有系列研究对患者在手术前后进行神经科医生的常规检查。
作者在欧洲颈动脉外科试验（ECST）中调查了接受CEA患者的颅神经损伤风险，该试验是接受CEA患者数量最多的系列研究，且在手术前后均进行了神经学评估。对每位患者的颅神经损伤进行评估和记录，并在随机分组后4个月和1年的随访检查中确定持续存在的功能缺损。通过单因素和多因素分析检查颅神经损伤的危险因素。在1739例接受CEA的患者中，有88例发生运动颅神经损伤（占患者的5.1%；95%置信区间[CI]4.1 - 6.2）。23例患者的功能缺损在出院时已恢复，3.7%的患者（95%CI 2.9 - 4.7）仍有残留颅神经损伤：27例舌下神经损伤、17例下颌缘支损伤、17例喉返神经损伤、1例副神经损伤和3例霍纳综合征。在4个月的随访检查中，只有9例患者（0.5%；95%CI 0.24 - 0.98）仍存在功能缺损；然而，在随后的随访中，持续存在的功能缺损均未恢复。只有手术时间超过2小时与颅神经损伤风险增加独立相关（风险比1.56，p < 0.0001）。
CEA后出院后仍持续存在的运动颅神经损伤风险约为4%。然而，绝大多数神经功能缺损在接下来的几个月内会恢复，永久性缺损很少见。尽管如此，在患者接受手术前，应告知其颅神经损伤的风险。
