During a carotid endarterectomy, which cranial nerves are particularly at risk for injury?

During a carotid endarterectomy, the hypoglossal nerve is particularly at risk for injury due to its anatomical location and proximity to the surgical site. The hypoglossal nerve (cranial nerve XII) innervates the muscles of the tongue and is critical for speech and swallowing. During the procedure, surgeons manipulate the carotid artery and may have to retract surrounding tissues, which increases the risk of compressing or damaging the hypoglossal nerve.

In contrast, while the vagus and accessory nerves also run in proximity to the surgical area, their functions and the extent of risk do not compare to that of the hypoglossal nerve during this specific type of surgery. The optic nerve is located significantly farther from the carotid artery, reducing its risk of injury during the procedure. Therefore, identifying the hypoglossal nerve as the cranial nerve at greatest risk highlights the need for careful dissection and surgical technique to preserve nerve function postoperatively.