1110. High flow Extracranial-Intracranial Bypass for the Treatment of Extensive Recurrent Nasopharyngeal Carcinoma in the Orientals: A Retrospective Review

Authors: Hon Yiu Chiu; Wai Man Lui (Hong Kong, Hong Kong)

Introduction: Cerebral vascular bypass is an important treatment strategy in skull base tumor and vascular conditions for example aneurysms, Moyamoya disease and radiation therapy-induced pseudoaneurysms. It also forms part of the treatment for extensive head and neck tumors that encases the internal carotid arteries. Nasopharyngeal carcinoma (NPC) is a common cancer in the orientals. Recurrent NPC however may be managed surgically. Tumor encasement of carotid arteries poses a challenge in resection. Extracranial-intracranial (ECIC) bypass operation allows radical tumor resection with preservation of cerebral blood flow. We would like to provide a retrospective review of the treatment outcomes of ECIC bypass operations performed in conjunction with NPC resections in Queen Mary Hospital, Hong Kong, with a focus on bypass success and patency. Methods: Bypass procedures performed for NPC tumor resection in our hospital between 2002 and 2017 were reviewed. Retrieved data include ischemic symptoms, graft patency and overall survival. Results: Twenty-three cases of recurrent NPC were treated by ECIC bypass operation and subsequent tumor resection. The median follow-up time was 15 months. Complete patency at 6 months and 3 years were 79% and 33% respectively. Ischemic symptoms were only present in 1 out of the 5 patients who had lost graft patency. The overall 3-year survival was 75%. No bypass-related mortality was reported in this group. Conclusion: ECIC bypass operation performed for NPC tumor resection in our center showed a reasonable patency rate. 3-year overall survival of our patients with extensive recurrent NPC involving the carotid arteries was comparable to the previously quoted overall survival in recurrent NPC patients who received re-irradiation. Citations: Sia, S.F. and M.K. Morgan, High flow extracranial-to-intracranial brain bypass surgery. J Clin Neurosci, 2013. 20 (1): p. 1-5.