{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T23:06:31Z","timestamp":1793315191704,"version":"4.5.0"},"reference-count":20,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2021,2,10]],"date-time":"2021-02-10T00:00:00Z","timestamp":1612915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Cerebral stroke continues to be one of the leading causes of mortality and long-term morbidity; therefore, carotid endarterectomy (CEA) remains to be a popular treatment for both symptomatic and asymptomatic patients with carotid stenosis. Cranial nerve injuries remain one of the major contributor to the postoperative morbidities. Anatomical dissections were carried out on 44 sides of 22 cadaveric heads following the classical CEA procedure to investigate the variations of the local anatomy as a contributing factor to cranial nerve injuries. Concurrence of two variations was found to be important in hypoglossal nerve injury: the presence of a direct smaller vein in proximity of the carotid bifurcation, and the intersection of the hypoglossal nerve (HN) with this vein. Based on the sample investigated, this variation was observed significantly higher on the right side. Awareness of possible anatomical variations and early ligation of any small veins can significantly decrease iatrogenic injury risk.<\/jats:p>","DOI":"10.3390\/brainsci11020211","type":"journal-article","created":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T00:49:26Z","timestamp":1613090966000},"page":"211","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The Carotid Endarterectomy Cadaveric Investigation for Cranial Nerve Injuries: Anatomical Study"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9898-3807","authenticated-orcid":false,"given":"Orhun Mete","family":"Cevik","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Ac\u0131badem Mehmet Ali Aydinlar University, 34662 Istanbul, Turkey"},{"name":"Department of Neurosurgery, Bak\u0131rkoy Training and Research Hospital for Psychiatric and Nervous Diseases, Health Sciences University, 34147 Istanbul, Turkey"},{"name":"(CASE) Center of Advanced Simulation ant Education, Ac\u0131badem Mehmet Ali Aydinlar University, 34684 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murat Imre","family":"Usseli","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ac\u0131badem Mehmet Ali Aydinlar University, 34662 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mert","family":"Babur","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Bak\u0131rkoy Training and Research Hospital for Psychiatric and Nervous Diseases, Health Sciences University, 34147 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cansu","family":"Unal","sequence":"additional","affiliation":[{"name":"(CASE) Center of Advanced Simulation ant Education, Ac\u0131badem Mehmet Ali Aydinlar University, 34684 Istanbul, Turkey"},{"name":"School of Medicine, Ac\u0131badem Mehmet Ali Aydinlar University, 34684 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murat Sakir","family":"Eksi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ac\u0131badem Mehmet Ali Aydinlar University, 34662 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Guduk","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ac\u0131badem Mehmet Ali Aydinlar University, 34662 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Talat Cem","family":"Ovalioglu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Bak\u0131rkoy Training and Research Hospital for Psychiatric and Nervous Diseases, Health Sciences University, 34147 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3227-2660","authenticated-orcid":false,"given":"Mehmet Emin","family":"Aksoy","sequence":"additional","affiliation":[{"name":"(CASE) Center of Advanced Simulation ant Education, Ac\u0131badem Mehmet Ali Aydinlar University, 34684 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Necmettin","family":"Pamir","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ac\u0131badem Mehmet Ali Aydinlar University, 34662 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5824-3249","authenticated-orcid":false,"given":"Baran","family":"Bozkurt","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ac\u0131badem Mehmet Ali Aydinlar University, 34662 Istanbul, Turkey"},{"name":"(CASE) Center of Advanced Simulation ant Education, Ac\u0131badem Mehmet Ali Aydinlar University, 34684 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,2,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1016\/0140-6736(92)91658-U","article-title":"Epidemiology of stroke","volume":"339","author":"Bonita","year":"1992","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1161\/01.STR.27.2.260","article-title":"A systematic review of the risks of stroke and death due to endarterectomy for symptomatic carotid stenosis","volume":"27","author":"Rothwell","year":"1996","journal-title":"Stroke"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1080\/00015458.2007.11680006","article-title":"Literature review of cranial nerve injuries during carotid endarterectomy","volume":"107","author":"Sajid","year":"2007","journal-title":"Acta Chir. Belg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/j.ejvs.2016.12.026","article-title":"Cranial nerve injury after carotid endarterectomy: Incidence, risk factors, and time trends","volume":"53","author":"Kakisis","year":"2017","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_5","first-page":"120","article-title":"The ansa cervicalis revisited","volume":"66","author":"Loukas","year":"2007","journal-title":"Folia Morphol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"221","DOI":"10.5115\/acb.19.041","article-title":"Ansa cervicalis: A comprehensive review of its anatomy, variations, pathology, and surgical applications","volume":"52","author":"Kikuta","year":"2019","journal-title":"Anat. Cell Biol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1308\/rcsann.2017.0176","article-title":"The significance of the pharyngeal veins during carotid endarterectomy: Description of an anatomical triangle","volume":"100","author":"Aldoori","year":"2018","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_8","first-page":"781","article-title":"A prospective study of the incidence of injury to the cranial nerves during carotid endarterectomy","volume":"151","author":"Hertzer","year":"1980","journal-title":"Surg. Gynecol. Obstet."},{"key":"ref_9","unstructured":"Hertzer, N.R. (2018). Postoperative Management and Complications of Extra Cranial Carotid Reconstruction. Vascular Surgery, WB Saunders Co.. [2nd ed.]."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/S0967-2109(98)00070-2","article-title":"The blood supply of the hypoglossal nerve and its relevance to carotid endarterectomy","volume":"7","author":"Fernando","year":"1999","journal-title":"Cardiovasc. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Charlesworth, D., and Greenhalgh, R. (1984). Vascular Surgical Techniques, \u201cCarotid Endarterectomy\u201d, Butterworths.","DOI":"10.1016\/B978-0-407-00351-4.50008-4"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"284","DOI":"10.4103\/2231-0746.175751","article-title":"Variant anatomy of internal jugular vein branching","volume":"5","author":"Deepak","year":"2015","journal-title":"Ann. Maxillofac. Surg."},{"key":"ref_13","first-page":"33","article-title":"Vagus Nerve Injury During Carotid Endarterectomy: A Cadaveric Study","volume":"16","author":"Bozkurt","year":"2020","journal-title":"Med. J. Bakirkoy"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/j.ejvs.2004.06.019","article-title":"Incidence of cranial nerve injuries after carotid eversion endarterectomy with a transverse skin incision under regional anaesthesia","volume":"28","author":"Assadian","year":"2004","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1007\/s00276-003-0138-6","article-title":"Persistent left superior vena cava and central venous catheter position: Clinical impact illustrated by four cases","volume":"25","author":"Schummer","year":"2003","journal-title":"Surg. Radiol. Anat."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1007\/s00276-008-0405-7","article-title":"Clinically relevant variations of the superior thyroid artery: An anatomic guide for surgical neck dissection","volume":"31","author":"Ozgur","year":"2009","journal-title":"Surg. Radiol. Anat."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1111\/j.1445-2197.2006.03913.x","article-title":"Anatomical variations of the common carotid artery bifurcation","volume":"76","author":"Lo","year":"2006","journal-title":"ANZ J. Surg."},{"key":"ref_18","unstructured":"Standring, S. (2008). Gray\u2019s Anatomy. The Anatomical Basis of Clinical Practice, Churchill Livingstone Elsevier."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1007\/s00276-008-0337-2","article-title":"Topography of carotid bifurcation: Considerations for neck examination","volume":"30","author":"Klosek","year":"2008","journal-title":"Surg. Radiol. Anat."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"244","DOI":"10.4314\/eamj.v85i5.9619","article-title":"Anatomical variations of the carotid arteries in adult Kenyans","volume":"85","author":"Anangwe","year":"2008","journal-title":"East Afr. Med. J."}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/11\/2\/211\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:22:15Z","timestamp":1760160135000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/11\/2\/211"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,10]]},"references-count":20,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,2]]}},"alternative-id":["brainsci11020211"],"URL":"https:\/\/doi.org\/10.3390\/brainsci11020211","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,10]]}}}