Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2025, Vol. 39 ›› Issue (4): 49-58.doi: 10.6040/j.issn.1673-3770.0.2024.228

• Clinical Research • Previous Articles     Next Articles

Treatment of internal carotid artery rupture caused by tumor recurrence and skull base osteonecrosis after radiotherapy for nasopharyngeal carcinoma

WANG Zaixing1, TANG Zhiyuan2, LI Dingbo1, SHI Zhaohui3, ZENG Xianhai1, ZHANG Qiuhang1,4   

  1. 1. Department of Otolaryngology, Shenzhen Longgang Otolaryngology hospital & Shenzhen Otolaryngology Research Institute, Shenzhen 518172, Guangdong, China2. Department of Otorhinolaryngology & Head and Neck Surgery, Shenzhen University General Hospital, Shenzhen 518055, Guangdong, China3. Department of Otorhinolaryngology & Head and Neck Surgery/Allergy/Naso-Orbital-Maxilla and Skull Base Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong, China4. Department of Otorhinolaryngology & Head and Neck Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100730, China
  • Online:2025-07-20 Published:2025-08-11

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Abstract: Objective To investigate the internal carotid artery protection techniques and perioperative management strategies of endoscopic surgery for local recurrent nasopharyngeal carcinoma or skull base osteonecrosis after radiotherapy for nasopharyngeal carcinoma. Methods The clinical data of patients with local recurrent nasopharyngeal carcinoma and skull base osteonecrosis of nasopharyngeal carcinoma who received endoscopic surgery at Department of Otolaryngology, Shenzhen Longgang Otolaryngology hospital from January 2019 to December 2023 were retrospectively analyzed. The gender and age of the patients near or involving the internal carotid artery were analyzed and summarized, the lesion site and its relationship with the internal carotid artery, the resection of the lesion, the protection methods of important blood vessels during the operation, the postoperative internal carotid artery bleeding and its management, and the postoperative recovery were analyzed and summarized. Results A total of 47 patients were included, with a male to female ratio of 25∶22 and an average age of 50.98±10.93 years. There were 29 cases of recurrence and 9 cases of internal carotid artery invasion. In the osteonecrosis group, the lesion invaded the internal carotid artery in 6 cases. During the postoperative follow-up, 5 patients in the recurrence group had tumour recurrence at the site adjacent to surgery, and the average recurrence time was 15 months. The incidence of postoperative internal carotid artery rupture bleeding was 6.9% and the mortality rate was 10.34%. In the osteonecrosis group, 1 patient was found to have recurrent osteonecrosis at 7 months after surgery and was treated again. The incidence of postoperative internal carotid artery rupture bleeding was 5.6% and the mortality was 11.11%. Bleeding occurred in the high internal carotid artery in both groups, and the lesions were found to have invaded the internal carotid artery before surgery. Conclusion For patients with local recurrence of nasopharyngeal carcinoma or with skull base osteonecrosis near or involving the internal carotid artery after radiotherapy, the extent of the tumour and surrounding major blood vessels should be fully evaluated before surgery, and the appropriate surgical protocols and management methods should be formulated. Surgical safety can be improved by mastering the surgical skills to protect the internal carotid artery and by paying attention to the protection of major blood vessels.

Key words: Local recurrent nasopharyngeal carcinoma, Skull base bone necrosis, Nasal endoscopic surgery, Internal carotid artery

CLC Number: 

  • R739.63
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