Encasement of the Cartoid Sheath

Encasement of the Carotid Sheath

Epidemiology

Cervical nodal enlargement is frequently encountered in patients with head and neck cancers. Nodal involvement is an important determinant of prognosis. The presence of lymphadenopathy reduces the prognosis by half. The carotid artery can be involved following advanced nodal metastasis with extracapsular spread (Fig. 166–1). Encasement of the carotid artery at the skull base may be due to perineural invasion along CN X.

Clinical Findings

Apart from the primary disease, carotid invasion may be silent. However, patients may have hoarseness of voice or Horner’s syndrome indicating tumor involvement of the carotid sheath.

Pathology

Carotid encasement may be due to direct extension of the primary tumor or advanced nodal metastases. The presence of carotid encasement should also be evaluated in patients with neck recurrence.