Stroke

Stroke is a rare, but functionally devastating complication of

neck dissection. The risk of stroke in older series ranged as high
as 4.8%. These studies, however, were retrospective and did not
account for variables such as smoking, which is also correlated
with the risk of stroke.
In a systematic review of NSQIP (National Surgical Quality
Improvement Program) data, Cramer et al reported an increased risk of stroke following a neck
dissection in patients
with at least two carotid artery stenosis (CAS) risk factors (age
older than 65 years, smoking, diabetes mellitus, hypertension,
congestive heart failure, renal failure, history of stroke or transient ischemic attack).23 The risk for
such patients was measured
at 2.86% for bilateral neck dissections, 0.41% for unilateral neck
dissection, and 0.24% for no neck dissection. Additionally,
stroke was significantly associated with 30-day mortality
(7.4%). Another large database study from Canada showed a
similar stroke rate in 30 days following surgery (0.7%) as compared to non–head and neck major
surgery. Similar risk factors
were identified, but the data were not reported separately for
the high-risk group.24 Additionally, the authors found a significant decrease in incidence from 1995
to 2012 (1.1–0.3%).
In patients with carotid artery disease, or risk factors for CAS,
extra care should be taken to avoid retraction of the carotid
sheath, and unnecessary manipulation of the carotid. If a very
high-grade stenosis is identified on imaging, consideration can
be made for preoperative endarterectomy, with careful consideration of the risk in the oncologic
context