Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2025, Vol. 39 ›› Issue (4): 19-25.doi: 10.6040/j.issn.1673-3770.0.2024.421

• Clinical Research • Previous Articles     Next Articles

Analysis of factors associated with stroke and cranial nerve palsy after unilateral internal carotid artery embolization in patients with nasopharyngeal carcinoma after radiotherapy

WANG Siquan1, ZHU Hongshen2, ZHANG Xiaobin3, ZHAO Zhouyang3, MA Yue3, YANG Yimei3, HUANG Lijin3   

  1. 1. Department of Neurosurgery, Xiangya Changde Hospital, Changde 415000, Hunan, China2. Department of Neurosurgery, Third Afffliated Hospital of Southern Medical University, Guangzhou 510630, Guangdong, China3. Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, Guangdong, China
  • Online:2025-07-20 Published:2025-08-11

PDF (PC)

64

Abstract: Objective To analyze the factors related to stroke and cranial nerve paralysis following unilateral internal carotid artery(ICA)embolization in patients with nasopharyngeal carcinoma after radiotherapy, in order to reduce the probability of postoperative complications and improve the quality of life for these patients. Methods A retrospective analysis was conducted on the clinical data of 109 patients who underwent unilateral ICA embolization in the Department of Neurosurgery at the Third Affiliated Hospital of Southern Medical University between March 1, 2018, and October 31, 2022. These patients were followed up for one month. Patients with postoperative symptoms of stroke or cranial nerve paralysis were defined as the symptomatic group(17 cases), while the rest were classified as the asymptomatic group(92 cases). Logistic regression analysis was performed on factors such as gender, age, body mass index(BMI), blood pressure, preoperative hemoglobin levels, the status of the ipsilateral ICA, whether the contralateral ICA was stenosed, whether the ophthalmic artery compensated for the middle cerebral artery, the occlusion segment, and the side of occlusion. Results There were no statistically significant differences between the symptomatic and asymptomatic groups in terms of gender, age, BMI, whether the contralateral ICA was stenosed, the side of occlusion, or the balloon occlusion test(BOT)(all P>0.05). However, there were statistically significant differences in the occlusion segment(P=0.001), the status of the occluded ICA(stenosis, normal, or presence of a pseudoaneurysm)(P=0.010), and preoperative hemoglobin levels(P=0.024)with respect to the occurrence of postoperative stroke/cranial nerve paralysis. Elevated hemoglobin levels(OR=0.971)were identified as a protective factor, while occlusion extending to the cavernous sinus segment(OR=2.292)was identified as a risk factor. Conclusion For patients with nasopharyngeal carcinoma requiring ICA occlusion, preoperative hemoglobin levels should be maintained at ≥90 g/L. Occlusion at segments below the cavernous sinus can reduce postoperative symptoms of cranial nerve paralysis, particularly oculomotor and abducens nerve paralysis.

Key words: Nasopharyngeal carcinoma, Cranial nerve paralysis, Stroke, Occlusion

CLC Number: 

  • R651.1
[1] Zhang YT, Rumgay H, Li MM, et al. Nasopharyngeal cancer incidence and mortality in 185 countries in 2020 and the projected burden in 2040: population-based global epidemiological profiling[J]. JMIR Public Health Surveill, 2023, 9: e49968. doi:10.2196/49968
[2] 刘冰, 单鹏. 血管损伤后假性动脉瘤形成机制及诊疗原则[J]. 中国实用外科杂志, 2014, 34(12): 1200-1202. doi:10.7504/CJPS.ISSN1005-2208.2014.12.28 LIU Bing, SHAN Peng. Formation mechanism and diagnosis and treatment principles of pseudoaneurysm after vascular injury[J]. Chinese Journal of Practical Surgery, 2014, 34(12): 1200-1202. doi:10.7504/CJPS.ISSN1005-2208.2014.12.28
[3] Zeng L, Wan W, Luo Q, et al. Retrospective analysis of massive epistaxis and pseudoaneurysms in nasopharyngeal carcinoma after radiotherapy[J]. Eur Arch Otorhinolaryngol, 2022, 279(6): 2973-2980. doi:10.1007/s00405-021-07111-x
[4] Jonas K, Meers A, Gao M. Complication of head and neck cancer: carotid blowout syndrome[J]. Am J Emerg Med, 2024, 77: 231.e5-231231.e6. doi:10.1016/j.ajem.2024.01.025
[5] Lin ZP, Zou XG, Chen Y, et al. Efficacy analysis of endovascular treatment for ruptured internal carotid artery pseudoaneurysm hemorrhage in patients with nasopharyngeal carcinoma after radiotherapy[J]. Front Surg, 2024, 11: 1451570. doi:10.3389/fsurg.2024.1451570
[6] Zhu WY, Huang J, Lu ZQ, et al. Management of post-radiation carotid blowout syndrome in patients with head and neck cancer: a systematic review[J]. Radiother Oncol, 2024, 200: 110502. doi:10.1016/j.radonc.2024.110502
[7] Tang R, Liu SX, Mao S, et al. Safety and efficacy of protective stent insertion to prevent carotid blowout syndrome at the distal internal carotid artery in nasopharyngeal carcinoma patients: a comparison with endovascular occlusion[J]. Quant Imaging Med Surg, 2024, 14(2): 1791-1802. doi:10.21037/qims-23-604
[8] 李海艳, 施展, 张强, 等. 鼻咽癌放疗后颈内动脉爆裂综合征的治疗策略[J]. 临床耳鼻咽喉头颈外科杂志, 2024, 38(6): 467-471. doi:10.13201/j.issn.2096-7993.2024.06.003 LI Haiyan, SHI Zhan, ZHANG Qiang, et al. Treatment strategy of carotid blowout syndrome after radiotherapy for nasopharyngeal carcinoma[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2024, 38(6): 467-471. doi:10.13201/j.issn.2096-7993.2024.06.003
[9] Plaforet V, Tournier L, Deschamps F, et al. Covered stent graft for treatment of carotid blowout syndrome in patients with head and neck cancer[J]. JAMA Otolaryngol Head Neck Surg, 2024, 150(11): 995-1001. doi:10.1001/jamaoto.2024.3228
[10] Wu WB, Zhang XB, Liu YP, et al. Stent pretreatment for internal carotid artery exposed to necrotic lesions in nasopharyngeal carcinoma[J]. Rhinology, 2023. doi:10.4193/Rhin22.451
[11] Yu KW, Ling K, Wu CH, et al. Endovascular management of intracranial carotid blowout syndrome in patients with head and neck cancer[J]. J Neurointerv Surg, 2025: jnis-2024-022221. doi:10.1136/jnis-2024-022221
[12] 黎劭学, 陈锦华, 张燕婷, 等. 球囊闭塞试验在颈内动脉永久闭塞术决策中的参考作用[J]. 局解手术学杂志, 2016, 25(8): 603-5. doi:10.11659/jjssx.09E015118 LI Shaoxue, CHEN Jinhua, ZHANG Yanting, et al. Role of balloon occlusion test in the treatment of permanent internal carotid artery occlusion[J]. Journal of Regional Anatomy and Operative Surgery, 2016, 25(8): 603-605. doi:10.11659/jjssx.09E015118
[13] Song JM, Lan L, Lv YQ, et al. Study on carotid artery stenosis after radiotherapy for nasopharyngeal carcinoma[J]. J Cancer Res Clin Oncol, 2024, 150(5): 273. doi:10.1007/s00432-024-05788-1
[14] 何引, 吴家森, 殷海. 经鼻内镜下鼻咽癌外科手术治疗进展[J]. 右江医学, 2023, 51(10): 944-949. doi:10.3969/j.issn.1003-1383.2023.10.015
[15] 赵洲洋, 黄理金, 陈锦华, 等. 鼻咽癌损伤颈内动脉的ASITN/SIR分级评估与栓塞策略[J]. 中华耳鼻咽喉头颈外科杂志, 2020, 55(7): 671-676. doi:10.3760/cma.j.cn115330-20200224-00121 ZHAO Zhouyang, HUANG Lijin, CHEN Jinhua, et al. Evaluation and embolization strategy by ASITN/SIR grade for injured internal carotid artery of nasopharyngeal carcinoma[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2020, 55(7): 671-676. doi:10.3760/cma.j.cn115330-20200224-00121
[16] Roberts DJ, Zygun DA. Anemia, red blood cell transfusion, and outcomes after severe traumatic brain injury[J]. Crit Care, 2012, 16(5): 154. doi:10.1186/cc11489
[17] Sekhon MS, McLean N, Henderson WR, et al. Association of hemoglobin concentration and mortality in critically ill patients with severe traumatic brain injury[J]. Crit Care, 2012, 16(4): R128. doi:10.1186/cc11431
[18] Liang HQ, Zhou YY, Xiong W, et al. Impact of radiotherapy for nasopharyngeal carcinoma on carotid stenosis risk: a meta-analysis[J]. Braz J Otorhinolaryngol, 2022,88(4):98-107. doi:10.1016/j.bjorl.2022.03.001
[19] Benson EP. Radiation injury to large arteries. 3. Further examples with prolonged asymptomatic intervals[J]. Radiology, 1973, 106(1): 195-197. doi:10.1148/106.1.195
[20] Louis EL, McLoughlin MJ, Wortzman G. Chronic damage to medium and large arteries following irradiation[J]. J Can Assoc Radiol, 1974, 25(2): 94-104
[21] Cheng SW, Wu LL, Ting AC, et al. Irradiation-induced extracranial carotid stenosis in patients with head and neck malignancies[J]. Am J Surg, 1999, 178(4): 323-328. doi:10.1016/s0002-9610(99)00184-1
[22] Luo CB, Teng MM, Chang FC. Radiation acute carotid blowout syndromes of the ascending pharyngeal and internal carotid arteries in nasopharyngeal carcinoma[J]. Eur Arch Otorhinolaryngol, 2006, 263(7): 644-646. doi:10.1007/s00405-006-0028-8
[23] Weber AL, al-Arayedh S, Rashid A. Nasopharynx: clinical, pathologic, and radiologic assessment[J]. Neuroimaging Clin N Am, 2003, 13(3): 465-483. doi:10.1016/s1052-5149(03)00041-8
[24] 刘慧, 何彩娴, 彭继勇, 等. 鼻咽癌放射治疗致放射性颈动脉损伤的研究进展[J]. 实用医学杂志, 2023, 39(10): 1201-1205. doi: 10.3969/j.issn.1006-5725.2023.10.002 LIU Hui, HE Caixian, PENG Jiyong, et al. Carotid arterial injuries caused by radiotherapy for nasopharyngeal carcinoma: a review[J]. The Journal of Practical Medicine, 2023, 39(10): 1201-1205. doi: 10.3969/j.issn.1006-5725.2023.10.002
[25] 谢志伟, 蔡义侠, 黄静. 鼻咽癌放疗致颈动脉损伤的研究进展[J]. 肿瘤防治研究, 2021, 48(11): 1041-1045. doi:10.3971/j.issn.1000-8578.2021.21.0570 XIE Zhiwei, CAI Yixia, HUANG Jing. Research progress of carotid artery injury caused by radiotherapy for nasopharyngeal carcinoma[J]. Cancer Research on Prevention and Treatment, 2021, 48(11): 1041-1045. doi:10.3971/j.issn.1000-8578.2021.21.0570
[26] Pensak ML. The cavernous sinus: an anatomic study with clinical implication[J]. Laryngoscope Investig Otolaryngol, 2024, 9(2): e1226. doi:10.1002/lio2.1226
[27] Sekhar LN, Schramm VL Jr, Jones NF, et al. Operative exposure and management of the petrous and upper cervical internal carotid artery[J]. Neurosurgery, 1986, 19(6): 967-982. doi:10.1227/00006123-198612000-00012
[28] Corvino S, Villanueva-Solórzano PL, Offi M, et al. A new perspective on the cavernous sinus as seen through multiple surgical corridors: anatomical study comparing the transorbital, endonasal, and transcranial routes and the relative coterminous spatial regions[J]. Brain Sci, 2023, 13(8): 1215. doi:10.3390/brainsci13081215
[29] Harris FS, Rhoton AL. Anatomy of the cavernous sinus[J]. J Neurosurg, 45(2): 169-180. doi:10.3171/jns.1976.45.2.0169
[30] Najera E, Ibrahim B, Muhsen BA, et al. Blood supply of cranial nerves passing through the cavernous sinus: an anatomical study and its implications for microsurgical and endoscopic cavernous sinus surgery[J]. Front Oncol, 2021, 11: 702574. doi:10.3389/fonc.2021.702574
[31] Krisht A, Barnett DW, Barrow DL, et al. The blood supply of the intracavernous cranial nerves: an anatomic study[J]. Neurosurgery, 1994, 34(2): 275-279;discussion279. doi:10.1227/00006123-199402000-00011
[32] 丰育功, 周运波, 王雅栋, 等. 海绵窦区颅神经血供的显微解剖及临床应用研究[J]. 中华神经外科疾病研究杂志, 2008, 7(2): 123-126. doi:10.3969/j.issn.1671-2897.2008.02.008 FENG Yugong, ZHOU Yunbo, WANG Yadong, et al. Microanatomy of blood supply of cranial nerves in cavernous sinus region and its clinical application[J]. Chinese Journal of Neurosurgical Disease Research, 2008, 7(2): 123-126. doi:10.3969/j.issn.1671-2897.2008.02.008
[1] QIU Qianhui, XIAO Xuping, YANG Qintai, YE Jing, DENG Zeyi, WANG Desheng, TAN Guolin, JIANG weihong,. Expert consensus on clinical management recommendations for carotid blowout syndrome secondary to NPC treatment [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2025, 39(4): 1-18.
[2] HUANG Qiao, REN Yi, HOU Tao, LIAO Xingwei, ZHU Zi’ang, ZHAN Xiaolin, LIU Ying, YIN Shihua. Expression of EphB2 in nasopharyngeal carcinoma tissues and its correlation with clinicopathological characteristics [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2025, 39(4): 26-30.
[3] SUN Chunxiao, WANG Wenqing, YUE Tian, LIU Jisheng. Efficacy analysis of concurrent chemoradiotherapy with high and low cumulative cisplatin doses in the treatment of nasopharyngeal carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2025, 39(4): 31-41.
[4] WANG Zaixing, TANG Zhiyuan, LI Dingbo, SHI Zhaohui, ZENG Xianhai, ZHANG Qiuhang. Treatment of internal carotid artery rupture caused by tumor recurrence and skull base osteonecrosis after radiotherapy for nasopharyngeal carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2025, 39(4): 49-58.
[5] SUN Fang, XIE Chubo, QIU Qianhui. Retrospective analysis of nutritional indexes and their impact on wound healing in patients with radiation-induced skull base osteoradionecrosis after treatment with nasopharyngeal carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2025, 39(4): 59-68.
[6] ZHU Ruikai, WU Jiarong, SUN Fang, XIE Chubo, QIU Qianhui. Computed tomography angiography-based assessment of internal carotid artery stenosis after radiotherapy for nasopharyngeal carcinoma and its associated factors [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2025, 39(4): 77-84.
[7] QIN Debo, XUE Jiancheng, YANG Wenyue, HU Bing, CHEN Tao, YU Yanping, MENG Qingguo, SUN Huanji, MIAO Beiping, LU Yongtian. Changing the diagnosis and treatment of nasopharyngeal cancer: biomarkers and nasal endoscopic surgery synergise to advance early treatment development [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2025, 39(4): 85-92.
[8] WU Jiarong, QIU Qianhui. The role and significance of the skull base fascial tissue barrier in endoscopic resection of locally early recurrent nasopharyngeal carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2025, 39(4): 108-113.
[9] YANG Ming, LIU Xuexia, ZHANG Hua. Progress of m6A recognition protein IGF2BPs in head and neck cancer [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2025, 39(3): 153-161.
[10] WU Min, LI Zhengyang, MENG Jie, YE Huiping. Molecular mechanisms of programmed cell death and its role in nasopharyngeal carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2025, 39(2): 152-157.
[11] ZHANG Maohua, WEI Rifu, ZHU Zhongshou, LIU Ping, GAO Shang, LI Huifeng. Effect of LncRNA PCAT-1 on the biological behaviour and chemosensitivity of nasopharyngeal carcinoma cells [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2025, 39(1): 68-76.
[12] ZHANG Jingyi, DONG Xiangyi, MU Yakui, SONG Xicheng. Research progress on pyroptosis in otorhinolaryngology diseases [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(4): 140-148.
[13] YANG Kaiyan, TANG Fengzhu, QIN Qicai, LI Xuxiang, FENG Dayi, NONG Fengjing, YANG Qiuyun. Expression of abnormal spindle-like microcephaly associated protein in nasopharyngeal carcinoma and its clinical significance [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(3): 18-25.
[14] BAO Ying, LIU Zhigao, JANG Pengfei, CUI Wenxuan, ZHENG Xiaoxia, YANG Mengyao, SI Mingwei, WANG Yu, WANG Hong. Clinical observation of compacept in the treatment of diabetes mellitus with CRVO-ME high reflex point [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(3): 55-60.
[15] DAI Honglei, WANG Qiuyang, MA Wenxue, GUAN Bin, QI Jingjing. To analyze the mortality trend of nasopharyngeal carcinoma based on Joinpoint regression and an age-period-cohort model [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(1): 27-31.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(2): 116 -118 .
[2] ZHOU Zi-ning,JIN Guo-wei . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(5): 462 -465 .
[3] XU Sainan,YANG Lei . Apoptosis of epithelial cells in nasal polyps promoted by erythromycin[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(1): 27 -29 .
[4] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(1): 94 -95 .
[5] LIU Lian-he . Treatment of deep neck abscess in 37 cases[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(2): 180 -181 .
[6] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 227 -227 .
[7] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 248 -249 .
[8] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 258 -259 .
[9] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 259 -259 .
[10] SUN Yan,ZHANG Qing-quan,ZHANG Hua,SONG Xi-cheng,ZHAO Li-min,WANG Yan,JIANG Shao-hong,WANG Qiang . Heterogenerty (cattle) acellular dermal matrix repairing mucosa in otolaryngology reconstruction surgeries[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(4): 316 -319 .
Website Copyright: Editorial Office of Journal of Otolaryngology and Ophthalmology of Shandong University
Address: No.27 Shanda South Road, Jinan, Shandong, China. Post code: 250100 Tel: +86-0531-88366912 Email: ebhxb@sdu.edu.cn Supported by Beijing Magtech Co.Ltd