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Palavani LB, Camerotte R, Pari Mitre L, Batista S, Banderali I, Vilardo M, Vieira Nogueira B, Pereira V, Macedo L, Bertani R, Rassi MS, de Oliveira JG. Evaluating the Potential of Preembolization Using Ethylene-Vinyl Alcohol (Onyx and Squid) in Carotid Body Tumor Paraganglioma. World Neurosurg 2024:S1878-8750(24)01427-X. [PMID: 39147025 DOI: 10.1016/j.wneu.2024.08.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 08/09/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVE This study aims to evaluate the efficacy and safety of preoperative embolization, used 48 hours before surgery to reduce tumor size and surgical complications in carotid body paragangliomas. METHODS This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis and Cochrane Handbook. A comprehensive literature search was performed in Medline, Embase, Web of Science, and Cochrane databases. The inclusion criteria were: 1) observational studies, 2) reporting on diagnosed carotid body paragangliomas, 3) undergoing preoperative embolization procedures, and 4) with ethylene-vinyl alcohol as an embolic agent. RESULTS The study analyzed 106 patients, aged 18-79, using primarily Onyx 18 for embolization, with treatment intervals ranging from 24 hours to 2 weeks. Efficacy outcomes showed near-total devascularization in 67% of cases (95% confidence interval [CI]: 0.47-0.87; I² = 74%), subtotal devascularization in 33% (95% CI: 0.12-0.54; I² = 43%), and total devascularization in 97% (95% CI: 0.88-1.00; I² = 41%), indicating significant heterogeneity across outcomes. The mean estimated blood loss was 184.46 ml (95% CI: 116.72-252.20 ml). Postembolization complication rate was exceptionally low at 1% (95% CI: 0.00-0.06; I² = 0%). CONCLUSIONS In conclusion, preoperative embolization of carotid body tumors achieved high rates of devascularization with minimal blood loss and a very low incidence of complications, highlighting its effectiveness and safety as a treatment strategy.
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Affiliation(s)
- Lucca B Palavani
- Faculty of Medicine, Max Planck University Center, São Paulo, Brazil.
| | - Raphael Camerotte
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lucas Pari Mitre
- Faculty of Medicine, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Sávio Batista
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Isabela Banderali
- Faculty of Medicine, Max Planck University Center, São Paulo, Brazil
| | - Marina Vilardo
- School of Medicine, Catholic University of Brasilia, Brasilia, Brazil
| | | | - Vinicius Pereira
- Department of Neurosurgery, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Leonardo Macedo
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Raphael Bertani
- Department of Neurosurgery, University of São Paulo, São Paulo, Brazil
| | - Márcio S Rassi
- Division of Neurosurgery, Department of Surgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Jean G de Oliveira
- Division of Neurosurgery, Department of Surgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
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Michel S, Ludovichetti R, Bertalan G, Thurner P, Madjidyar J, Schubert T, Däppen MB, Nölting S, Huber A, Kulcsar Z. Endovascular Embolization as a Stand-Alone Treatment of Head and Neck Paragangliomas with Long-Term Tumor Control. AJNR Am J Neuroradiol 2024:ajnr.A8328. [PMID: 38719606 DOI: 10.3174/ajnr.a8328] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/30/2024] [Indexed: 08/03/2024]
Abstract
BACKGROUND AND PURPOSE The impact of therapeutic embolization as a stand-alone treatment of head and neck paragangliomas considered surgically high-risk remains insufficiently understood. The aim of this study was to investigate the procedural risks and long-term volumetric development in head and neck paragangliomas with high surgical risk following therapeutic endovascular embolization as a stand-alone treatment. MATERIALS AND METHODS A retrospective database review of patients who underwent endovascular embolization as primary treatment for head and neck paragangliomas lacking appropriate curative treatment options at our institution (from January 2000 to February 2023) was conducted. Tumor volumetric analyses were performed before embolization and during follow-up. To assess the changes in tumor volume over time, the measurements were performed after embolization, first at 6 months and then on a yearly basis up to 6 years (mean follow-up time was 33.7 ± 24.4 months). Subgroup analyses were conducted for vagal and jugular/jugulotympanic paragangliomas. RESULTS A total of 32 head and neck paragangliomas in 28 patients (mean age, 56.1 years ± 16.5 [standard deviation]; 18 female) with therapeutic embolization as stand-alone treatment were evaluated, of which 11 were vagal paragangliomas, 15 jugular/jugulotympanic paragangliomas, and 6 carotid body tumors. After a mean follow-up duration of 33.7 ± 24.4 months, tumor control was achieved in 75%, with significant median tumor volume reduction at 6 months (P = .02, n = 21). Vagal paragangliomas responded the most to embolization with a significantly decreased median volume from 22.32 cm3 to 19.09 cm3 (P = .008, n = 8). Transient complications occurred in 3.4%. CONCLUSIONS Therapeutic embolization as a stand-alone treatment offers a low-risk control of tumor growth in surgically high-risk lesions, with a significant reduction in tumor volume after treatment. Among the different subtypes, vagal paragangliomas exhibited the strongest and longest regression of the tumor volume.
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Affiliation(s)
- Samira Michel
- From the Faculty of Medicine (S.M.), University of Zurich, Zurich, Switzerland
| | - Riccardo Ludovichetti
- Department of Neuroradiology, Clinical Neuroscience Center (R.L., G.B., P.T., J.M., T.S., Z.K.), University Hospital of Zurich, Zurich, Switzerland
| | - Gergely Bertalan
- Department of Neuroradiology, Clinical Neuroscience Center (R.L., G.B., P.T., J.M., T.S., Z.K.), University Hospital of Zurich, Zurich, Switzerland
| | - Patrick Thurner
- Department of Neuroradiology, Clinical Neuroscience Center (R.L., G.B., P.T., J.M., T.S., Z.K.), University Hospital of Zurich, Zurich, Switzerland
| | - Jawid Madjidyar
- Department of Neuroradiology, Clinical Neuroscience Center (R.L., G.B., P.T., J.M., T.S., Z.K.), University Hospital of Zurich, Zurich, Switzerland
| | - Tilman Schubert
- Department of Neuroradiology, Clinical Neuroscience Center (R.L., G.B., P.T., J.M., T.S., Z.K.), University Hospital of Zurich, Zurich, Switzerland
| | - Martina Broglie Däppen
- Department of Otorhinolaryngology, Head and Neck Surgery (M.B.D., A.H.), University Hospital of Zurich, Zurich, Switzerland
| | - Svenja Nölting
- Department of Endocrinology, Diabetology and Clinical Nutrition (S.N.), University Hospital of Zurich, Zurich, Switzerland
| | - Alexander Huber
- Department of Otorhinolaryngology, Head and Neck Surgery (M.B.D., A.H.), University Hospital of Zurich, Zurich, Switzerland
| | - Zsolt Kulcsar
- Department of Neuroradiology, Clinical Neuroscience Center (R.L., G.B., P.T., J.M., T.S., Z.K.), University Hospital of Zurich, Zurich, Switzerland
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Wang YH, Yang J, Zhong H, Wu JJ, Wu K, Hu A, Wu JY, Zhu JH. Prevalence, characteristics, evaluation, and management of carotid body tumors: Systematic analysis based on available evidence. J Vasc Surg 2024; 80:574-585.e4. [PMID: 38580159 DOI: 10.1016/j.jvs.2024.03.443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/18/2024] [Accepted: 03/28/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE Although carotid body tumors (CBTs) are rare, they attract particular attention because of their propensity for malignant transformation and the high surgical risk. Because data are scarce and as it is difficult to achieve a large sample size, no study has yet comprehensively analyzed the characteristics, management, or operative complications of CBTs. Therefore, we collected and analyzed all currently available information on CBTs and used the pooled data to derive quantitative information on disease characteristics and management. METHODS We systematically searched PubMed, Embase, the Cochrane Library, and the Web of Science up to December 1, 2022, for studies that investigated the characteristics and management of CBTs. The primary objective was to identify the prevalence of the various characteristics and the incidence of complications. The secondary objective was to compare patients who underwent preoperative embolization (PE) and those who did not (non-PE), as well as to compare patients with different Shamblin grades and those with and without succinate dehydrogenase (SDH) mutations in terms of CBT characteristics and complications. Two reviewers selected studies for inclusion and independently extracted data. All statistical analyses were performed using the standard statistical procedures of Review Manager 5.2 and Stata 12.0. RESULTS A total of 155 studies with 9291 patients and 9862 tumors were identified. The pooled results indicated that the median age of patients with CBT was 45.72 years, and 65% were female. The proportion of patients with bilateral lesions was 13%. In addition, 16% of patients had relevant family histories, and the proportion of those with SDH gene mutations was 36%. Sixteen percent of patients experienced multiple paragangliomas, and 12% of CBTs had catecholamine function. The incidence of cranial nerve injury (CNI) was 27%, and 14% of patients suffered from permanent CNI. The incidence rates of operative mortality and stroke were both 1%, and 4% of patients developed transient ischemic attacks. Of all CBTs, 6% were malignant or associated with metastases or recurrences. The most common metastatic locations were the lymph nodes (3%) and bone (3%), followed by the lungs (2%). Compared with non-PE, PE reduced the estimated blood loss (standardized mean difference, -0.95; 95% confidence interval [CI], -1.70 to -0.20) and the operation time (standardized mean difference, -0.56; 95% CI, -1.03 to -0.09), but it increased the incidence of stroke (odds ratio, 2.44; 95% CI, 1.04-5.73). Higher Shamblin grade tumors were associated with more operative complications. Patients who were SDH gene mutation-positive were more likely to have a relevant family history and had more symptoms. CONCLUSIONS CBT was most common in middle-aged females, and early surgical resection was feasible; there was a low incidence of serious operative complications. Routine PE is not recommended because this may increase the incidence of stroke, although PE somewhat reduced the estimated blood loss and operation time. Higher Shamblin grade tumors increased the incidence of operative complications. Patients who were SDH gene mutation-positive had the most relevant family histories and symptoms.
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Affiliation(s)
- Yong-Hong Wang
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning, China; Medical College of Qinghai University, Qinghai University, Xi'ning, China
| | - Jia Yang
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning, China; Medical College of Qinghai University, Qinghai University, Xi'ning, China
| | - Hao Zhong
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning, China; Medical College of Qinghai University, Qinghai University, Xi'ning, China
| | - Jun-Jie Wu
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning, China; Medical College of Qinghai University, Qinghai University, Xi'ning, China
| | - Kai Wu
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning, China; Medical College of Qinghai University, Qinghai University, Xi'ning, China
| | - Anguo Hu
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning, China; Medical College of Qinghai University, Qinghai University, Xi'ning, China
| | - Jian-Ying Wu
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning, China; Medical College of Qinghai University, Qinghai University, Xi'ning, China
| | - Ji-Hai Zhu
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning, China; Medical College of Qinghai University, Qinghai University, Xi'ning, China.
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Ridha B, Aram V, Baram A, Hama Baqi SY, Yaldo F. Surgical outcomes for carotid body tumour resection without preoperative embolization: a 10-year experience. Ann Med Surg (Lond) 2024; 86:2181-2188. [PMID: 38576983 PMCID: PMC10990344 DOI: 10.1097/ms9.0000000000001847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/04/2024] [Indexed: 04/06/2024] Open
Abstract
Background Carotid body tumours (CBTs) are neoplasms originating from the paraganglionic cells of the carotid body. Excision is the main route of treatment. This study sought to assess the surgical outcomes of post-carotid body tumour resection without preoperative embolization and discern any underlying relationships between modified Shamblin classes (MSC) and related complications. Methods A retrospective medical record review of prospectively collected data is performed at Sulaymaniyah Teaching Hospital between 2008 and 2019, for 54 patients. Presurgical and postsurgical variables such as comorbidities and complications were noted, respectively. Results Patient ages ranged between 26 and 60 years (x̄=40.06) with a minimal female predominance (57.4%). Complications included one minor stroke. MSC and postoperative complications were significantly related (P≤0.001). Our analyses also suggested a significant relationship between intraoperative blood loss and the incidence of postoperative complications (P=0.001, χ²=25). The MSC III subtype was significantly associated with intraoperative blood loss (P=0.000), length of stay (P=0.000), and operating time (P=0.001). Conclusions Our study purports a strong relationship between greater MSC and complications of all types. As such, surgeons may benefit from preoperative strategies to minimize complications.
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Affiliation(s)
- Barzany Ridha
- College of Medicine University of Saskatchewan, 2222 Wascana Greens, Regina, SK, Canada
| | - Varin Aram
- College of Medicine, Slemani Teaching Hospitals University of Sulaimani
| | - Aram Baram
- Department of Cardiothoracic and Vascular Surgery, College of Medicine University of Sulaimani, Sulaimani Shar Teaching Hospital Al Sulaymaniyah Iraq
| | - Soren Younis Hama Baqi
- Kurdistan Board for medical specialties, Cardiothoracic and Vascular Surgeon, Kurdistan Region, Iraq
| | - Fitoon Yaldo
- Pediatric Cardiothoracic Surgery Fellow-Queensland Children Hospital FKBMS Cardiothoracic and Vascular Surgery 501 Stanley St, South Brisbane, QLD, Australia
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Abdullah A, Hamzah A, Alsudais AS, Alzahrani RS, Souror H, Alqarni GS, Ashqar AA, Hemeq YH, Dakkak O. A Global Bibliometric Analysis of the Top 100 Most Cited Articles on Carotid Body Tumors. Cureus 2024; 16:e54754. [PMID: 38524015 PMCID: PMC10961149 DOI: 10.7759/cureus.54754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 03/26/2024] Open
Abstract
The carotid body, situated at the common carotid artery bifurcation, comprises specialized glomus cells responsible for sensing blood oxygen, carbon dioxide, pH, and temperature changes, crucial for regulating breathing and maintaining oxygen homeostasis. Carotid body tumors (CBTs), arising from these cells, are rare, representing only 0.5% of head and neck tumors, often presenting as benign, slow-growing, vascularized masses. In February 2023, this bibliometric analysis was conducted, which involved screening 1733 articles from the Web of Science database. The screening process was based on citation count, and articles were selected for inclusion based on specific criteria that focused on CBTs located within the carotid bifurcation. Rigorous selection involved independent screening and data extraction by four authors. The top 100 articles, published between 1948 and 2019, totaled 6623 citations and were authored by 98 unique first authors from 22 countries and 77 institutions, spanning 42 journals. Treatment articles were the predominant category, comprising 49% of the literature. This analysis offers insights into publication trends, identifies literature gaps, and outlines areas of research focus, providing a valuable resource to guide future studies on CBTs.
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Affiliation(s)
- Abdullah Abdullah
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Abdulaziz Hamzah
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Department of Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Ali S Alsudais
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Department of Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Raghad S Alzahrani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Department of Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Hatem Souror
- College of Medicine, University of Jeddah, Jeddah, SAU
| | | | - Afnan A Ashqar
- College of Medicine, Batterjee Medical College, Jeddah, SAU
| | - Yousef H Hemeq
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Department of Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Omar Dakkak
- Department of Surgery (Vascular Surgery), International Medical Center Hospital, Jeddah, SAU
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Mahajan A, Shaikh A, Shukla S, Vaish R, Agarwal U, Smriti V, Rastogi S, Deokar S, Suryavanshi S, Chaturvedi P, Laskar SG, Prabhash K, Patil V, Noronha V, Menon N, Pai P, Pantvaidya G, Rane SU, Bal M, Mittal N, Patil A, Dcruz AK. MR imaging-based risk stratification scoring system to predict clinical outcomes in carotid body tumors. Front Oncol 2024; 13:1200598. [PMID: 38348117 PMCID: PMC10860202 DOI: 10.3389/fonc.2023.1200598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 12/12/2023] [Indexed: 02/15/2024] Open
Abstract
Objectives This study aims to evaluate the role of pretherapy MRI in predicting outcomes in carotid body tumors and propose a grading system for high- and low-risk characteristics. Materials and methods A retrospective observational study of 44 patients with 51 lesions was carried out from year 2005 to 2020. MR images were reviewed for characteristics of carotid body tumor, and a score was given that was correlated with intra- and postoperative findings. The various other classifications and our proposed Mahajan classification were compared with Shamblin's classification. The area under the curve and ROC curves were used to present the accuracy of different predictive models. Results Our scoring system allotted a score of 0 to 15 on the basis of MRI characteristics, with scores calculated for patients in our study ranging from 0 to 13. Lesions with scores of 0-6 were considered low risk (45%), and scores of 7-15 were regarded as high risk for surgery (55%). The Mahajan classification stages tumors into four grades: I (10%), II (20%), IIIa (8%), and IIIb (62%). The frequency of vascular injury was 50% in category I and 64% in category IIIb. The frequency of cranial nerve injury was 50%, 66%, and 27% in categories I, II, and IIIb. Conclusion The Mahajan classification of CBTs evaluates high-risk factors like the distance of the tumor from the skull base and the angle of contact with ICA, which form the major predictors of neurovascular damage and morbidity associated with its surgery. Though the Shamblin classification of CBT is the most widely accepted classification, our proposed Mahajan classification system provides an imaging-based alternative to prognosticate surgical candidates preoperatively.
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Affiliation(s)
- Abhishek Mahajan
- Department of Imaging, The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- Department of Radiology, Tata Memorial Hospital, Mumbai, India
| | - Atif Shaikh
- Department of Radiology, Tata Memorial Hospital, Mumbai, India
| | - Shreya Shukla
- Department of Radiology, Tata Memorial Hospital, Mumbai, India
| | - Richa Vaish
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Ujjwal Agarwal
- Department of Radiology, Tata Memorial Hospital, Mumbai, India
| | | | - Shivam Rastogi
- Department of Radiology, Tata Memorial Hospital, Mumbai, India
| | - Shonal Deokar
- Department of Radiology, Tata Memorial Hospital, Mumbai, India
| | | | - Pankaj Chaturvedi
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | | | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Nandini Menon
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Prathamesh Pai
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Gouri Pantvaidya
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | | | - Munita Bal
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Neha Mittal
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Asawari Patil
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Anil Keith Dcruz
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, India
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Zhiqiang L, Yihua W, Ying F, Shiwei Z, Xiangzhu Z, Ligang C. The value of color doppler ultrasonography combined with computed tomography angiography and magnetic resonance angiography in the preoperative quantification and classification of carotid body tumors: a retrospective analysis. BMC Med Imaging 2024; 24:10. [PMID: 38172706 PMCID: PMC10765896 DOI: 10.1186/s12880-023-01189-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/28/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) provide accurate vascular imaging information, but their use may be contraindicated. Color Doppler ultrasonography (CDU) provides simple, safe, noninvasive, and reproducible imaging. We therefore investigated the role of preoperative CDU combined with CTA and MRA in the quantification, typing, and diagnosis of carotid body tumors (CBTs). METHODS We retrospectively analyzed patients with CBTs categorized into group A (type I [n = 1] and type II [n = 10]) or group B (type III [n = 56]) per the intraoperative Shamblin classification. CDU, CTA, and MRA characteristics of CBTs were observed, surgical results were correlated, and the diagnostic threshold of the CBT classification was calculated. RESULTS CBTs were usually located at the common carotid artery bifurcation, encircling the carotid artery. An increased angle was found between the internal and external carotid arteries. On CDU, CBTs primarily presented as homogeneous hypoechoic masses with clear boundaries, rich flow signals, and a high-speed, low-resistance artery-like flow spectrum. CTA showed uniform or heterogeneous marked enhancement. MRA showed mixed T1 and slightly longer T2 signals and uniform or uneven obvious enhancement. With increases in the lesion size, amount of blood transfused, and operation time, the intraoperative classification level and possibility of skull-base invasion increased. When the maximum diameter of the lesion, the volume of the tumor, the distance between the upper margin of the tumor to the mastoid and the mandibular angle were 3.10 cm, 10.15 cm3, - 3.26 cm, and 0.57 cm, respectively, the largest Youden index was the best diagnostic boundary value for Shamblin type III tumors. CONCLUSIONS CDU combined with CTA and MRA can accurately evaluate the size and classification of CBTs.
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Affiliation(s)
- Li Zhiqiang
- Department of Ultrasound Medicine, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, P.R. China.
| | - Wang Yihua
- Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, 73 South Jianshe Rd, Lubei District, Tangshan, 063000, P.R. China
| | - Fu Ying
- Department of Ultrasound Medicine, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, P.R. China
| | - Zhu Shiwei
- Department of Ultrasound Medicine, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, P.R. China
| | - Zeng Xiangzhu
- Department of Radiology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, P.R. China
| | - Cui Ligang
- Department of Ultrasound Medicine, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, P.R. China
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Kilic Y, Jalalzai I, Sönmez E, Erkut B, Jalalzai M. The Surgical Treatment of Carotid Body Tumor as Well as the Prevention and Management of Complications. Cureus 2024; 16:e51807. [PMID: 38322070 PMCID: PMC10846755 DOI: 10.7759/cureus.51807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 02/08/2024] Open
Abstract
The carotid body tumor (CBT) is a rare paraganglioma neoplasm that often occurs in the head and neck anatomical region. Carotid angiography continues to be widely regarded as the preferred diagnostic method for this particular malignancy. Surgical intervention has been widely acknowledged as the primary approach for managing CBTs. However, the resection of CBTs poses significant technical challenges due to its specific anatomical position. To mitigate the incidence of intraoperative and postoperative challenges, we have conducted a comprehensive review of both domestic and international literature to consolidate the surgical approach and strategies for preventing and managing complications associated with this particular tumor.
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Affiliation(s)
- Yasin Kilic
- Cardiovascular Surgery, Ataturk University Hospital, Erzurum, TUR
| | | | - Ebubekir Sönmez
- Cardiovascular Surgery, Ataturk University Hospital, Erzurum, TUR
| | - Bilgehan Erkut
- Cardiovascular Surgery, Ataturk University Hospital, Erzurum, TUR
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Luna-Ortiz K, Bautista-Pérez IJ, Luna-Peteuil Z, Martinez-Hernandez HJ. Carotid Artery Resection and Reconstruction due to Benign and Malignant Head and Neck Tumors. Indian J Otolaryngol Head Neck Surg 2023; 75:4216-4222. [PMID: 37974813 PMCID: PMC10645706 DOI: 10.1007/s12070-023-04068-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/06/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE Carotid resection for head and neck cancer is rare, and serious complications may arise since such cancer is frequently detected in advanced stages. The objective is to describe nine cases of carotid artery resection and reconstruction due to tumor invasion. METHODS The clinical records of nine patients who underwent carotid resection and reconstruction at our hospital were retrospectively reviewed. Carotid body tumors were evaluated with the aid of a vascular team in case carotid resection was necessary at the time of surgery. CT angiography to determine the status of the circle of Willis was performed in all patients who might undergo carotid resection and reconstruction in case of failure to restore cerebral blood flow and thus reduce possible sequelae due to ligation. RESULTS Of nine patients, 6 had carotid body tumors, 1 had a thyroid tumor of conglomerate lymph nodes, 1 had a larynx tumor of conglomerate lymph nodes, and 1 had a myofibroblastic tumor. There were no intraoperative cerebrovascular accidents. One patient (11.1%) had a cerebrovascular accident secondary to carotid hematoma in the intermediate postoperative period that required vascular graft removal. One patient (11.1%) died seven days after surgery following an ischemic cerebrovascular accident. Eight patients remain asymptomatic, and 1 patient with recurrence and metastasis. CONCLUSIONS Carotid resection remains a controversial issue in the treatment of advanced head and neck cancer. However, carotid resection and reconstruction are required for disease control, and complications such as thrombosis or vascular accidents may arise. Fortunately, this is a rare condition. We recommend carotid reconstruction for all patients in whom resection is required for tumor control. Ligation should be a last resort, as seen in the management of one of our patients.
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Affiliation(s)
- Kuauhyama Luna-Ortiz
- Department of Head and Neck Surgery, Instituto Nacional de Cancerología, Av San Fernando #22 Col. Sección XVI, Mexico City, 14080 Tlalpan Mexico
- Department of General Surgery (Head and Neck Surgery, Hospital General “Manuel Gea Gonzalez”, Mexico City, México
| | - Irvint Joel Bautista-Pérez
- Department of Head and Neck Surgery, Instituto Nacional de Cancerología, Av San Fernando #22 Col. Sección XVI, Mexico City, 14080 Tlalpan Mexico
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Nan L, Ruimeng Y, Guangqi C, Yonghui H. Preoperative embolization is necessary for large-volume carotid body tumor (≥ 6670 mm 3) resection. Eur Arch Otorhinolaryngol 2023; 280:4177-4183. [PMID: 37395760 DOI: 10.1007/s00405-023-07990-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/18/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND To investigate the impact of preoperative embolization (p-TAE) on CBT surgical resection and explore the optimal tumor volume for p-TAE of CBT resection. METHODS This retrospective study reviewed 139 surgically excised CBTs. According to Shamblin classification, tumor volumes, and whether to carry out the p-TAE, the patients were classified into different groups. The demographic, clinical features, and the intraoperative and post-operative information about the patients were retrieved and analyzed from the patient records. RESULTS A total of 139 CBTs was excised in 130 patients. According to the results of subgroup analysis, there were no significant differences in surgical time, blood loss, adverse events (AEs), and the revascularization when compared with non-embolization group (NEG) for type I, II, III, respectively (all p > 0.05) except for the surgical time in type I (p < 0.05). Then the X-tile program was employed and determine the cutoff point (tumor volume = 6670 mm3) for tumor volumes and blood loss. The average tumor volume was (29,782.37 vs. 31,345.10 mm3, p = 0.65) for embolization group (EG) and NEG. The mean surgical time (208.86 vs. 264.67 min, p > 0.05) and intraoperative blood loss (252.78 vs. 430.00 mL, p < 0.05) were less, and the incidence of revascularization required (35.56 vs. 52.38%, p > 0.05) and total complications (27.78 vs. 57.14%, p < 0.05) were lower in EG when compared with NEG (tumor volume ≥ 6670 mm3). However, the results were not statistically significant when the tumor size was less than 6670 mm3. No surgery-related mortality was observed during the follow-up. CONCLUSIONS Preoperative selective embolization of CBT is an effective and safe adjunct for surgical resection, especially for Shamblin class II and III tumors (≥ 6670 mm3).
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Affiliation(s)
- Li Nan
- The First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China
- Department of Interventional Radiology, Guangzhou First People's Hospital, Guangzhou, 510180, China
- Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
| | - Yang Ruimeng
- Department of Interventional Radiology, Guangzhou First People's Hospital, Guangzhou, 510180, China
| | - Chang Guangqi
- Department of Vascular Surgery, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China.
| | - Huang Yonghui
- Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China.
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Kihara C, Patel S, Moss R. A Rapidly Progressing Carotid Body Tumor: A Case Report. Cureus 2023; 15:e43654. [PMID: 37719473 PMCID: PMC10505067 DOI: 10.7759/cureus.43654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/17/2023] [Indexed: 09/19/2023] Open
Abstract
Carotid body tumors (CBTs) are a rare form of paragangliomas that often arise near the carotid bifurcation. They are typically slow growing and often asymptomatic. We report a case of a CBT in a 70-year-old man, who presented with a firm, painless, pulsatile neck mass that rapidly increased in size over the course of two months. The diagnosis was suspected based on the patient's clinical history and physical examination. The diagnosis was confirmed with CT angiography (CTA). The tumor was nonfunctioning based on normal urinary-free catecholamines, vanillylmandelic acid (VMA), and metanephrines levels. The patient then underwent a CT scan of his thorax, abdomen, and pelvis which did not detect any metastatic spread. The patient was referred to a tertiary vascular surgery center for definitive treatment. Our aim in presenting this case is to increase awareness of this rare type of paraganglioma with the hope of increasing early intervention and improving outcomes.
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Affiliation(s)
- Colby Kihara
- Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | | | - Roger Moss
- Family Medicine, Decatur Morgan Hospital, Decatur, USA
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12
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Ghoddusi Johari H, Afshari A, Abolhasani Foroughi A, Khademi B, Shahriarirad S, Erfani A, Zeinali-Rafsanjani B, Saeedi-Moghadam M, Shahriarirad R. Association of Complications during and after Carotid Body Tumor Resection with Tumor Size and Distance to the Base of Skull. Ann Vasc Surg 2023:S0890-5096(23)00147-4. [PMID: 36906133 DOI: 10.1016/j.avsg.2023.02.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE Depending on the size and location of the tumor, carotid body tumor (CBT) resection can come with various complications, mostly intraoperative bleeding, and cranial nerve injuries. In the present study, we aim to evaluate two fairly new variables, tumor volume, and distance to the base of the skull (DTBOS), with operative complications of carotid body tumor (CBT) resection. METHOD Patients who underwent carotid body tumor surgery in Namazi hospital from 2015 to 2019 were studied using standard databases. Tumor characteristics and distance to the base of the skull were measured via computed tomography or Magnetic resonance imaging. Outcomes, including intraoperative bleeding and cranial nerve injuries, along with perioperative data were collected. RESULTS A total of 42 cases of CBT were evaluated with an average age of 53.21±12.8 and mostly female (85.7%). Based on Shamblin scoring, 2 (4.8%) were classified as group I, 25 (59.5%) as group II, and 15 (35.7%) as group III. The amount of bleeding significantly increased with an increase in the Shamblin scores (P=0.031; median: I: 45cc; II: 250cc, III: 400cc). Also, there was a significant positive correlation between the size of the tumor and the estimated amount of bleeding (Correlation Coefficient = 0.660; P<0.001), and also a significant reverse correlation with between bleeding and DTBOS (Correlation Coefficient= -0.345; P=0.025). During the follow-up of the patients, six (14.3%) had abnormalities in their neurological evaluation. Receiver operating characteristic curve analysis revealed the size of tumor cutoff level 32.7 cm3 (3.2cm radius) to be most predictive of post-op neurological complication with an area under the curve=0.83, sensitivity=83.3%, specificity=80.6%, a negative predictive value= 96.7%, and positive predictive value of 41.7%, and an accuracy of 81.0%. Furthermore, based on the predictive power of the models in our study, we demonstrated that a combination model including the tumor size, DTBOS, along with the Shamblin score had the most predictive power for neurological complications. CONCLUSION By evaluating CBT size and distance to the base of the skull, paired with the use of the Shamblin classification, a better, more insightful understanding of possible risks and complications of CBT resection can be obtained, leading to deserved levels of patient care.
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Affiliation(s)
- Hamed Ghoddusi Johari
- Trauma Research Center, Vascular Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran; Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Afshin Afshari
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amin Abolhasani Foroughi
- Medical Imaging Research Center, Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bijan Khademi
- Department of Otorhinolaryngology, Khalili Hospital-Shiraz Institute for Cancer Research-Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sepehr Shahriarirad
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirhossein Erfani
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mahdi Saeedi-Moghadam
- Medical Imaging Research Center, Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Chen S, Xu J, Gu G, Zhang Y, Zhang J, Zheng Y, Huang Y. Perioperative blood pressure and heart rate alterations after carotid body tumor excision: a retrospective study of 108 cases. BMC Anesthesiol 2022; 22:374. [PMID: 36463127 PMCID: PMC9719143 DOI: 10.1186/s12871-022-01917-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/18/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Arising from chemoreceptor cells, carotid body tumors (CBTs) are rare neoplasms associated with hemodynamics. Perioperative changes in blood pressure (BP) and heart rate (HR) are not completely understood. METHODS This retrospective, observational, controlled study included all CBT patients from 2013 to 2018 in Peking Union Medical College Hospital. Perioperative changes in BP/HR within or between unilateral/bilateral/control groups were investigated. Perioperative details across Shamblin types were also assessed. RESULTS This study included 108 patients (116 excised CBTs). The postoperative systolic BP and HR increased in both unilateral (mean difference of systolic BP = 5.9mmHg, 95% CI 3.1 ~ 8.6; mean difference of HR = 3.7 bpm, 95% CI 2.6 ~ 4.9) and bilateral (mean difference of systolic BP = 10.3mmHg, 95% CI 0.6 ~ 19.9; mean difference of HR = 8.4 bpm, 95% CI 0.5 ~ 16.2) CBT patients compared with the preoperative measures. Compared with control group, the postoperative systolic BP increased (difference in the alteration = 6.3mmHg, 95% CI 3.5 ~ 9.0) in unilateral CBT patients; both systolic BP (difference in the alteration = 9.2mmHg, 95% CI 1.1 ~ 17.3) and HR (difference in the alteration = 5.3 bpm, 95% CI 1.0 ~ 9.6) increased in bilateral CBT patients. More CBT patients required extra antihypertensive therapy after surgery than controls (OR = 2.5, 95% CI 1.14 ~ 5.5). Maximum tumor diameter, intraoperative vascular injury, continuous vasoactive agent requirement, total fluid volume, transfusion, estimated blood loss, operation duration, postoperative pathology, overall complications, and intensive care unit/hospital lengths of stay significantly varied among Shamblin types. CONCLUSION CBT excision may be associated with subtle perioperative hemodynamic changes. Perioperative management of CBT patients necessitates careful assessment, full preparation and close postoperative monitoring.
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Affiliation(s)
- Si Chen
- grid.506261.60000 0001 0706 7839Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, 100730 Beijing, China ,grid.506261.60000 0001 0706 7839State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 100730 Beijing, China
| | - Jingjing Xu
- grid.506261.60000 0001 0706 7839Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Dongcheng District, 100730 Beijing, China ,grid.12527.330000 0001 0662 3178School of Medicine, Tsinghua University, 100084 Beijing, China
| | - Guangchao Gu
- grid.506261.60000 0001 0706 7839State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 100730 Beijing, China ,grid.506261.60000 0001 0706 7839Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Dongcheng District, 100730 Beijing, China
| | - Yuelun Zhang
- grid.506261.60000 0001 0706 7839Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, 100730 Beijing, China
| | - Jiao Zhang
- grid.506261.60000 0001 0706 7839Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, 100730 Beijing, China
| | - Yuehong Zheng
- grid.506261.60000 0001 0706 7839State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 100730 Beijing, China ,grid.506261.60000 0001 0706 7839Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Dongcheng District, 100730 Beijing, China
| | - Yuguang Huang
- grid.506261.60000 0001 0706 7839Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, 100730 Beijing, China
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14
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Araujo-Castro M, Redondo López S, Pascual-Corrales E, Polo López R, Alonso-Gordoa T, Molina-Cerrillo J, Moreno Mata N, Caballero Silva U, Barberá Durbán R. Surgical and non-surgical management of thoracic and cervical paraganglioma. ANNALES D'ENDOCRINOLOGIE 2022:S0003-4266(22)00857-5. [PMID: 36334803 DOI: 10.1016/j.ando.2022.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 12/24/2022]
Abstract
Thoracic and cervical paragangliomas (PGLs) are rare neuroendocrine tumors arising from chromaffin cells of the neural crest progenitors located outside the adrenal gland. We describe our current protocol as a multidisciplinary team for the management of cervical and thoracic PGLs. Surgery is generally considered the treatment of choice as it offers the best chance for cure. For resection of thoracic PGLs, video-assisted thoracoscopic surgery (VATS) is the main surgical approach, while open thoracotomy is preferred in case of tumors > 6cm, lacking confirmation of a plane of separation with adjacent structures, or with technical difficulties during VATS. In cervical PGLs, the surgical approach should be individualized according to location, mainly based on the Glasscock-Jackson and the Fisch-Mattox classifications. Surgery is the treatment of choice for most cervical and thoracic PGLs, but radiotherapy or observation could be more suitable options in unresectable cervical and thoracic PGLs or when resection has been incomplete.
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Affiliation(s)
- Marta Araujo-Castro
- Neuroendocrinology Division, Department of Endocrinology & Nutrition & IRYCIS, Hospital Universitario Ramón y Cajal & Universidad de Alcalá, Madrid, Spain.
| | - Sandra Redondo López
- Department of Vascular Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Eider Pascual-Corrales
- Neuroendocrinology Division, Department of Endocrinology & Nutrition & IRYCIS, Hospital Universitario Ramón y Cajal & Universidad de Alcalá, Madrid, Spain
| | - Rubén Polo López
- Department of Otorhinolaryngology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Teresa Alonso-Gordoa
- Department of Medical Oncology, Hospital Universitario Ramón y Cajal & IRYCIS, Madrid, Spain
| | - Javier Molina-Cerrillo
- Department of Medical Oncology, Hospital Universitario Ramón y Cajal & IRYCIS, Madrid, Spain
| | - Nicolás Moreno Mata
- Department of Thoracic Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Usue Caballero Silva
- Department of Thoracic Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Rafael Barberá Durbán
- Department of Otorhinolaryngology, Hospital Universitario Ramón y Cajal, Madrid, Spain
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15
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Dwivedi G, Bharadwaja S, Kovilapu UB, Swain P, Kumari A. Carotid Body Tumor: A Case Report and Review of Literature. Indian J Otolaryngol Head Neck Surg 2022; 74:2409-2416. [PMID: 36452787 PMCID: PMC9702211 DOI: 10.1007/s12070-020-02189-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022] Open
Abstract
Carotid body tumour (CBT) is a rare hypervascular tumor in the head and neck region. It develops from neural crest origin paraganglionic tissue which is an arterial chemoreceptor. It presents as a slow growing mass at the carotid bifurcation. Its optimal evaluation and treatment requires involvement of multiple specialities. Because of the high rate of neurovascular complications, resection of this tumor is challenging for surgeons. Early tumor detection, meticulous evaluation and multidisciplinary approach are vital for successful management of these tumors. A case of CBT in a 50 year-old lady managed at our centre is being reported here along with a review of literature.
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16
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Fink-Josephi G, Hurtado-López LM, Hernández-Valencia AF, Higuera-Calleja JA, Guerrero-Avendaño G. Two stage, hybrid endovascular and open surgical approach to treat difficult carotid body tumors. Head Neck 2022; 44:2803-2809. [PMID: 36129095 DOI: 10.1002/hed.27190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/24/2022] [Accepted: 08/31/2022] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Present the feasibility, applicability, clinical effectiveness, and results of complicated Shamblin II or III carotid body tumors treated with a two-stage hybrid surgical approach. MATERIALS AND METHODS Retrospective, observational, cross-sectional, descriptive study of the successful treatment of 16 cases of difficult Shamblin II or III carotid body tumors, consisting of a two-stage surgical approach. We conducted a retrospective, observational, cross-sectional, descriptive study of a series of patients with complicated Shamblin II or III carotid body tumors, which we treated with a two-stage hybrid surgical procedure, in which we first placed a carotid endoprosthesis and 45 days later performed surgical resection of the tumor, following our originally published technique. This study was conducted from February, 2007 to November, 2019, in a third level care centre. RESULTS We treated 16 patients with a mean age of 50.5 years. All resided at more than 2000 meters above sea level. In all 16 a complete resection was performed. The average duration of surgery was 103.9 min, the average intraoperative bleeding was 69 ml. There were three cases of neuropraxia. The ansa cervicalis nerve had to be sectioned in three cases and there was permanent upper laryngeal nerve injury in two cases. There were no permanent cerebrovascular injuries from placement of the endoprostheses. One patient developed transient cerebral ischaemia (TIA) with no long-term sequelae. There were two cases of asymptomatic late occlusion of the endoprostheses. The average initial volume of the tumors was 54.4 cc. The average tumor volume 35 days after implant of the endoprosthesis was 30.9 cc. SYMPTOMS Presence of tumors in the neck in all cases and two cases of dysphagia. CONCLUSION This two-stage hybrid technique allowed for the complete resection of difficult Shamblin II or III carotid body tumors, with one case of TIA and two with permanent upper laryngeal nerve injuries and without mortality.
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Affiliation(s)
| | | | | | | | - Guadalupe Guerrero-Avendaño
- Neurosurgery Service, Hospital General de México, Mexico City, Mexico.,Interventional Radiology Service, Hospital General de México, Mexico city, Mexico
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17
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Sarookhani A, Chegini R. Carotid Body Tumor: Our Experience with 42 Patients and a Literature Review. Indian J Otolaryngol Head Neck Surg 2022; 74:279-286. [PMID: 36213462 PMCID: PMC9535048 DOI: 10.1007/s12070-021-02453-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/08/2021] [Indexed: 10/22/2022] Open
Abstract
To review characteristics, signs, diagnostic methods, and surgical complications in patients with carotid body tumor, in addition to a literature review. This was a cross-sectional study carried out on 42 patients with carotid body tumors referred to Al-Zahra hospital of Isfahan from January 1, 2016, to December 31, 2019. The studied characteristics included age at the onset of symptoms, gender, symptoms, duration of symptomatic status before diagnosis, diagnostic methods, pathological outcome, tumor stage, and surgical complications. The collected data were analyzed using SPSS 21. In this study, 34 patients (80.96%) were female. The mean age at the onset of symptoms was 54.41 years. The mean duration of symptoms before diagnosis was 12.55 months. There was no significant difference between genders for the age and duration of symptoms before diagnosis (p > 0.05). Symptoms were mainly painless mass, hoarseness, coughing, earache, tinnitus, and headache. After surgery, two cases of permanent cranial nerve injuries were found. Thirty-nine patients (93%) were diagnosed by ultrasound imaging and CT scan. We had one case of arterial repair. There was one malignant and one functional tumor. According to the results, carotid body tumor is more common in females especially on the right side. Bilateral tumors are prevalent in females. This mass should be removed by surgery at the time of diagnosis in cases where the patient is not at high risk for surgery due to comorbidities, and the risk of complications following surgery is low. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-021-02453-8.
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Affiliation(s)
- Abbas Sarookhani
- Department of Surgery, School of Medicine Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rojin Chegini
- Metabolic Liver Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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18
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Li N, Wan Y, Chen W, Yang J, Chang G, Huang Y. Beneficial effects of preoperative superselective embolization on carotid body tumor surgery: A 13-year single-center experience. Front Oncol 2022; 12:930127. [PMID: 35992888 PMCID: PMC9389645 DOI: 10.3389/fonc.2022.930127] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeThis study presented our 13-year experience managing patients with CBTs (carotid body tumors) and was aimed to investigate the impact of pre-TAE (preoperative transarterial embolization) on CBT surgical resection.MethodsThis retrospective study reviewed 169 surgically excised CBTs between May 2007 and October 2020. According to whether to carry out the pre-TAE, the patients were classified into the embolization (EG) (n = 130) and non-embolization groups (NEG) (n = 39). Tumor classification was based on Shamblin criteria and tumor size. The demographic data, clinical features, and intraoperative and postoperative information about the patients were retrieved and analyzed.ResultsThe average tumor size was (43.49 vs. 35.44 mm, p = 0.04) for EG and NEG. The mean surgical time (195.48 vs. 205.64 mins, p = 0.62) and intraoperative BL (blood loss) (215.15 vs. 251.41 cc, p = 0.59) were less, but the incidence of revascularization required (29% vs. 33%, p = 0.62) and total complications (26% vs. 36%, p = 0.32) were lower in EG compared to NEG. Similarly, according to the subgroup analysis, no significant differences were detected in the surgical time, BL, adverse events (AEs), and the revascularization in EG when compared to NEG for type I (n = 5 vs. 7), II (n = 105 vs. 27), and III (n = 20 vs. 5), respectively except for the surgical duration in type III (p < 0.05). However, a significantly lower incidence of AEs (230.25 vs. 350 cc, p = 0.038) and a decline in BL (28.57% vs. 48.15%, p = 0.049) in EG were observed compared to those in NEG patients for large CBTs (≥ 30 mm as the cutoff point). No surgery-related mortality was observed during the follow-up.ConclusionsCBTs can be surgically resected safely and effectively with a need for pre-TAE, which significantly decreases the overall BL and AEs for large lesions (≥ 30 mm).
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Affiliation(s)
- Nan Li
- Department of Interventional Radiology, Guangzhou First People’s Hospital, Guangzhou, China
| | - Yuan Wan
- Interventional Center, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wei Chen
- Department of Interventional Radiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jianyong Yang
- Department of Interventional Radiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guangqi Chang
- Department of Vascular Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Yonghui Huang, ; Guangqi Chang,
| | - Yonghui Huang
- Department of Interventional Radiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Yonghui Huang, ; Guangqi Chang,
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19
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Clinical Characteristics and Surgical Outcomes of Carotid Body Tumors: Data from the Carotid Paraganglioma Cooperative International Registry (CAPACITY) Group. World J Surg 2022; 46:2507-2514. [DOI: 10.1007/s00268-022-06663-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 10/16/2022]
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20
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The value of ultrasound for the preoperative assessment of carotid body tumors. Clin Imaging 2022; 87:38-42. [PMID: 35487160 DOI: 10.1016/j.clinimag.2022.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/07/2022] [Accepted: 04/19/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To evaluate the value of ultrasound (US) examination for the preoperative assessment of carotid body tumors (CBTs) and to predict surgical outcomes. METHODS A total of 15 CBT lesions in 15 patients were included in this study. CBT measurements determined using US, and included maximal diameter, volume, tumor distance to base of skull (DTBOS), and carotid wall infiltration. A correlation analysis was conducted to determine the correlation between US measurements and surgical outcomes, including estimated blood loss (EBL), cranial nerve injury, surgical time, and hospital length of stay (HLOS). RESULTS EBL showed a high level of correlation with the maximal dimeter (r = 0.596, p < .05) and the volume of the tumor (r = 0.864, p < .05). Surgical time was positively correlated with tumor volume (r = 0.592, p < .05) and negatively correlated with DTBOS (r = -0.554, p < .05). There was no significant correlation (p > .05) shown between cranial nerve injury and US variables. HLOS showed the high degree of correlation with the maximal dimeter (r = 0.658, p < .05), and was also negatively correlated with DTBOS (r = -0.620, p < .00). CONCLUSIONS US examination allows for the visualization of features of CBTs, which is a useful and safe tool to be used to predict surgical outcomes. Further research is necessary to validate this exploration method for the preoperative assessment of CBTs.
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Bhattacharjee S, Jain RD, Bathala L, Hk A, Sharma VK. Pictorial Essay of Cervical Duplex Ultrasonography. POCUS JOURNAL 2022; 7:245-252. [PMID: 36896382 PMCID: PMC9983729 DOI: 10.24908/pocus.v7i2.15635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objectives: Cervical duplex ultrasonography (CDU) is a simple, non-invasive, portable technique, that provides valuable high-quality visual information about the integrity of the carotid and vertebral vessels, plaque morphology and flow hemodynamics. CDU is useful in the assessment and follow up of patients with cerebrovascular disease as well as other conditions like inflammatory vasculitis, carotid artery dissection and carotid body tumours. CDU is inexpensive and invaluable in smaller centres. Methods: CDU was performed in all patients in both longitudinal and transverse planes in the out-patient clinic. Brightness mode (B-mode) and Doppler waveforms were obtained. Relevant findings were presented. Results: CDU provides real time visualisation of plaque characteristics and follow up, hemodynamic characteristics in Takayasu arteritis, visualisation of dissection. Conclusion: With availability of MR/CT angiography, CDU can be an adjuvant in follow up, triage and early bed-side diagnosis of the vascular diseases. We present our experience with CDU in the out-patient clinics in this pictorial essay.
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Affiliation(s)
| | | | | | | | - Vijay K Sharma
- Division of Neurology, Yong Loo Lin School of Medicine, National University of Singapore, National University Hospital Singapore
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Borghese O, Ferrer C, Pisani A, Camaioni A, Giudice R. Shamblin III Chemodectoma: The vascular surgeon's point of view. JOURNAL DE MEDECINE VASCULAIRE 2021; 46:209-214. [PMID: 34862014 DOI: 10.1016/j.jdmv.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
Chemodectomas (CBTs) are the most frequently encountered tumours at the carotid bifurcation. Even if rare and commonly benign, their development close to the head and neck structures is often source of morbidity by compression and infiltration. Therefore, in order to avoid permanent neurologic or vascular complications these infrequent lesions need to be early removed. The total excision may be technically challenging and requires extensive expertise in surgical neck anatomy and a cooperative multidisciplinary approach. Almost a quarter of CBTs infiltrate carotid vessels so vascular expertise is pivotal in their resection. The present study aims to give an overview of vascular specificity and procedures required during surgical excision of such tumors to assist and guide treating physicians who encounter CBTs. This overview will particularly emphasize current therapeutic options: we discuss the referral criteria that should guide the decision about what type of preoperative care and surgical procedure should be offered to the affected patients. We also specify the epidemiologic data, screening recommendations and outcomes achieved with the different therapeutic approaches. The clinical, operative and follow-up data about a case of a Shamblin III carotid body tumour surgically removed by a multidisciplinary team at our Institution are also reported.
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Affiliation(s)
- Ottavia Borghese
- Departement of Surgery Pietro Valdoni, University Sapienza, Viale del Policlinico, 00100 Rome, Italy.
| | - Ciro Ferrer
- Department of Vascular and Endovascular Surgery, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Angelo Pisani
- Departement of Cardiac Surgery, Pineta Grande Hospital, Castel Volturno, Italy
| | - Angelo Camaioni
- Department of Head and Neck Surgery, San Giovanni-Addolorata Hospital, Rome (RM), Italy
| | - Rocco Giudice
- Department of Vascular and Endovascular Surgery, San Giovanni-Addolorata Hospital, Rome, Italy
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23
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Mehanna H, Mistry P, Golusinski P, Di Maio P, Nankivell P, Snider F, Ferrante AMR, Montalto N, Nicolai P, Marcantoni A, Grandi C, Zavatta M, Grego F, Malec K, Hosal S, Suslu N, Kuscu O, Torrealba I, Valdes F, Sharma N, Ayuk J, Monksfield P, Irving R, Dunn JA, Kay M, Borsetto D. Development and validation of an improved classification and risk stratification system for carotid body tumors: Multinational collaborative cohort study. Head Neck 2021; 43:3448-3458. [PMID: 34418219 DOI: 10.1002/hed.26844] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 07/20/2021] [Accepted: 08/02/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND This study aims to develop and validate a new classification system that better predicts combined risk of neurological and neurovascular complications following CBT surgery, crucial for treatment decision-making. METHODS Multinational retrospective cohort study with 199 consecutive cases. A cohort of 132 CBT cases was used to develop the new classification. To undertake external validation, assessment was made between the actual complication rate and predicted risk by the model on an independent cohort (n = 67). RESULTS Univariate analyses showed statistically significant associations between developing a complication and the following factors: craniocaudal dimension, volume, Shamblin classification, and Mehanna types. In the multivariate prognostic model, only Mehanna type remained as a significant risk predictor. The risk of developing complications increases with increasing Mehanna type. CONCLUSIONS We have developed and then validated a new classification and risk stratification system for CBTs, which demonstrated better prognostic power for the risk of developing neurovascular complications after surgery.
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Affiliation(s)
- Hisham Mehanna
- Institute for Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | | | - Pawel Golusinski
- Department of Head and Neck Surgery, The Greater Poland Cancer Centre, Poznan University of Medical Sciences, Poznan, Poland
| | - Pasquale Di Maio
- Section of Otolaryngology - Head and Neck Surgery, University of Perugia, Perugia, Italy
| | - Paul Nankivell
- Institute for Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | - Francesco Snider
- Vascular Surgery Unit, Department of Cardiovascular Sciences, Policlinico Universitario A. Gemelli Foundation, Università Cattolica del S. Cuore, Rome, Italy
| | - Angela M R Ferrante
- Vascular Surgery Unit, Department of Cardiovascular Sciences, Policlinico Universitario A. Gemelli Foundation, Università Cattolica del S. Cuore, Rome, Italy
| | - Nausica Montalto
- Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | | | - Cesare Grandi
- Department of Otolaryngology, Ospedale S. Chiara, Trento, Italy
| | - Marco Zavatta
- Clinic of Vascular and Endovascular Surgery, Padova University School of Medicine, Padova, Italy
| | - Franco Grego
- Clinic of Vascular and Endovascular Surgery, Padova University School of Medicine, Padova, Italy
| | - Kataryna Malec
- Department of Otolaryngology - Head and Neck Surgery, 5th Military Hospital with Polyclinic, Krakow, Poland
| | - Sefik Hosal
- Department of Otolaryngology - Head and Neck Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Nilda Suslu
- Department of Otolaryngology - Head and Neck Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Oguz Kuscu
- Department of Otolaryngology - Head and Neck Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ignacio Torrealba
- Department of Vascular and Endovascular Surgery, Medical School, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Valdes
- Department of Vascular and Endovascular Surgery, Medical School, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Neil Sharma
- Institute for Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | - John Ayuk
- Department of Endocrinology, University Hospitals Birmingham Foundation Trust, Birmingham, UK
| | - Peter Monksfield
- Institute for Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | - Richard Irving
- Institute for Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | | | - Mark Kay
- Department of Vascular Surgery, University Hospitals Birmingham Foundation Trust, Birmingham, UK
| | - Daniele Borsetto
- Institute for Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
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24
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Li N, Zeng N, Wan Y, Wen C, Yang J, Li J, Dai H, Liao C, Tang K, Wang J, Chang G, Huang Y. The earlier, the better: The beneficial effect of different timepoints of the preoperative transarterial embolization on ameliorating operative blood loss and operative time for carotid body tumors. Surgery 2021; 170:1581-1585. [PMID: 34376306 DOI: 10.1016/j.surg.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND To explore the effect of the optimal time interval from preoperative transarterial embolization to surgery of carotid body tumors by analyzing surgery-related indicators. METHODS This single-center retrospective review included 103 patients and 108 carotid body tumor resections performed between June 2010 and June 2020. All carotid body tumors were divided into three groups based on interval time between transarterial embolization and surgery: 1-day group (G1), 2-day group (G2), and 3-day group (G3). Demographics, inflammatory biomarkers, periprocedural details, and postoperative outcomes were analyzed. RESULTS Among 103 patients, 48.54% were women, and the mean age was 37.07 years. The tumor sizes were 43.83, 44.31, and 42.84 mm in G1, G2, and G3, respectively, and the blood loss and operative time were 163.68, 331.54, and 683.68 mL, and 182.32, 216.31, and 280.79 mins with the prolonged time interval, respectively. Compared with pretransarterial embolization, the expression of white blood cells (109/L) and neutrophils (109/L) were obviously increased post-transarterial embolization in the three groups (G1: white blood cells 6.81 vs 9.32; neutrophils 0.54 vs 0.74, all P < .05. G2: white blood cells 7.19 vs 10.01, P = .118; neutrophils 0.54 vs 0.77, P < .05. G3: white blood cells 7.08 v. 12.37; neutrophils 0.59 vs 0.80, all P < .05), and those in G3 were significantly higher than those in G1. The incidences of revascularization, which was 30.26%, 53.85%, and 42.10%, and adverse events (26.32%, 30.77%, and 21.05%) were not significantly different among G1, G2, and G3. CONCLUSION The optimal time interval between preoperative transarterial embolization and surgical resection resulted as 1 day as patients in this group showed obvious lower blood loss and shorter duration of operation than patients in other groups. Both inflammation and recanalization provided support for these results at some extent.
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Affiliation(s)
- Nan Li
- Department of Interventional Radiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China; Department of Interventional Radiology, Guangzhou First People's Hospital, the Second Affiliated Hospital of South China University of Technology, Guangzhou, China
| | - Ni Zeng
- Center for Translational Medicine, Institute of Precision Medicine, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Yuan Wan
- Department of Interventional Radiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Chunyong Wen
- Department of Interventional Radiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Jianyong Yang
- Department of Interventional Radiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Jiaping Li
- Department of Interventional Radiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Haitao Dai
- Department of Interventional Radiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Changli Liao
- Department of Interventional Radiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Keyu Tang
- Department of Interventional Radiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Jingsong Wang
- Department of Vascular Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Guangqi Chang
- Department of Vascular Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Yonghui Huang
- Department of Interventional Radiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.
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25
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Tang H, Jiang X, Xue S, Fu W, Tang X, Guo D. Long-Term Surgical Outcomes of Carotid Body Tumors With Pathological Fibrosis: A Cohort Study. Front Oncol 2021; 11:684600. [PMID: 34350114 PMCID: PMC8327168 DOI: 10.3389/fonc.2021.684600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/01/2021] [Indexed: 12/05/2022] Open
Abstract
Objective To compare the surgical outcomes of carotid body tumor (CBT) with or without pathological fibrosis, and evaluate the associated factors of fibrous CBT (FCBT). Materials and Methods Paraffin-embedded tissues of 236 patients with unilateral CBTs at our center were retrospectively reviewed from January 2008 to May 2020. Based on the pathologic features, CBTs were divided into FCBT and conventional CBT (CCBT) groups. The clinical data and surgical outcomes of the two groups were compared. Results Of 236 patients, 53 had FCBT and 183 had CCBT. FCBTs showed higher vascular invasion (24.53%), marked pleomorphism (22.64%), internal carotid artery reconstruction (37.74%), estimated blood loss (559.62 cm3), and postoperative nerve injury (49.06%), with lower 10-year recurrence- (89.2%) and major adverse event-free survival (87.3%) compared to CCBTs. Nerve injury was correlated with the Shamblin grade; major adverse events and nerve injury were both correlated with pathological fibrosis. Conclusion Compared with CCBT, FCBT is prone to increased recurrence, metastasis, major adverse events, and nerve injury risk. Early surgical resection, routine excision of surrounding abnormal lymph nodes, and closer clinical surveillance in FCBT patients are recommended.
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Affiliation(s)
- Hanfei Tang
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaolang Jiang
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Song Xue
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Weiguo Fu
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiao Tang
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Daqiao Guo
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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26
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A novel classification of carotid body tumors. Eur J Surg Oncol 2021; 47:1813-1815. [PMID: 34023167 DOI: 10.1016/j.ejso.2021.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/07/2021] [Indexed: 11/22/2022] Open
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27
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Li X, Zhang W, Shu C, Li Q, Zhang L, Zhu J. Diagnosis and outcomes of surgical treatment of carotid bifurcation tumors. J Int Med Res 2021; 48:300060520976495. [PMID: 33317387 PMCID: PMC7739102 DOI: 10.1177/0300060520976495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To retrospectively review our experience with the diagnosis and treatment of carotid bifurcation tumors (CBFT). Methods This was a retrospective study of 60 patients with CBFT who underwent surgical and conservative treatment. The patients’ clinicopathological features, imaging examination findings, treatment strategy, and prognosis were analyzed. The surgical grade, blood loss, tumor size, operative time, and postoperative complications were analyzed by Spearman’s correlation. Results Resection was performed in 52 patients with 53 tumors. The mean tumor volume, operative time, estimated blood loss, and follow-up time was 47.62 ± 65.28 cm3, 176.1 ± 86.55 minutes, 231.3 ± 354.0 mL, and 44.42 ± 29.30 months, respectively. Pathological examination showed that the number of carotid body tumors (CBT; paraganglioma), neurilemmoma, mesenchymal tissue tumor, and angioleiomyoma was 42, 8, 1, and 1, respectively. Of the CBT group, the rate of Shamblin Type I, II, and III was 11.9%, 59.5%, and 28.6%, and three cases were malignant CBT with lymph node metastasis. Spearman’s correlation analysis showed that complication grade was significantly related to surgical difficulty grade and operative time. Conclusion CBT is the most frequent lesion in CBFT, and CBT may be treated safely by surgical management. The severity of surgical complications is significantly correlated with surgical difficulty.
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Affiliation(s)
- Xin Li
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Vascular Diseases Institute of Central South University, Changsha, Hunan, China
| | - Weichang Zhang
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Vascular Diseases Institute of Central South University, Changsha, Hunan, China
| | - Chang Shu
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Vascular Diseases Institute of Central South University, Changsha, Hunan, China.,Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, China
| | - Quanming Li
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Vascular Diseases Institute of Central South University, Changsha, Hunan, China
| | - Lei Zhang
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Vascular Diseases Institute of Central South University, Changsha, Hunan, China
| | - Jieting Zhu
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Vascular Diseases Institute of Central South University, Changsha, Hunan, China
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28
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Jasper A, Mammen S, Gowri MS, Keshava SN, Selvaraj D. Imaging criteria to predict Shamblin group in carotid body tumors - revisited. ACTA ACUST UNITED AC 2021; 27:354-359. [PMID: 33769292 DOI: 10.5152/dir.2021.20028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE This study aims to compare the imaging findings of carotid body tumors on contrast-enhanced computed tomography (CT) with the intraoperative Shamblin grade and to evolve an imaging-based scoring system that can accurately predict the Shamblin grade. METHODS Preoperative contrast-enhanced CT scans of 40 patients who underwent surgical excision of carotid body tumors in our institution between 2004 and 2017 were retrospectively reviewed. The angle of contact with the internal carotid artery (ICA), tumor volume, presence of peritumoral tuft of veins, loss of tumor adventitia interface and distance from the skull base were assessed and compared with the intraoperative Shamblin grades of the tumor. Ordinal logistic regression was used to determine which parameters could be predictors of the Shamblin grades. Receiver operator characteristic (ROC) curves were used to score the tumor volumes. RESULTS Among the 42 tumors evaluated, 6 (14.3%) were surgically classified as Shamblin I, 15 (35.7%) as Shamblin II, and 21 (50%) as Shamblin III tumors. Pairwise comparison between the three Shamblin groups showed a statistically significant difference for angle of contact with ICA, maximum tumor dimension, presence of peritumoral tuft of veins and loss of tumor adventitia interface (p = 0.001, p = 0.001, p = 0.038 and p = 0.003, respectively). However, tumor volumes and distance from skull base were not significantly different between the Shamblin groups (p = 0.136 and p = 0.682). A scoring system, including four of the above mentioned parameters (angle of contact with ICA, tumor volume, presence of peritumoral tuft of veins, and loss of tumor adventitia interface) was developed with a maximum score of 8 and a minimum of 2. A statistically significant difference was found between the final scores among the three Shamblin groups (p < 0.001). Using ROC curves, a final score of ≥6 was found to separate Shamblin grade III tumors from grade I and II tumors (sensitivity, 95.24%; specificity, 71.43%). All patients with documented intraoperative estimated blood loss of >1000 mL had Shamblin grade III tumors. Postoperative complications like stroke, ICA thrombosis and lower cranial nerve palsies were seen only with Shamblin grade II and III tumors. CONCLUSION The simple scoring system we have proposed correlates well with the Shamblin grade and helps in identifying patients who have a higher risk of developing complications.
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Affiliation(s)
- Anitha Jasper
- Department of Radiology, Christian Medical College, Vellore, India
| | - Suraj Mammen
- Department of Radiology, Christian Medical College, Vellore, India
| | | | | | - Dheepak Selvaraj
- Department of Vascular Surgery, Christian Medical College, Vellore, India
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Gu G, Wu X, Ji L, Liu Z, Li F, Liu B, Liu C, Ye W, Chen Y, Shao J, Zeng R, Song X, Guan H, Zheng Y. Proposed modification to the Shamblin's classification of carotid body tumors: A single-center retrospective experience of 116 tumors. Eur J Surg Oncol 2021; 47:1953-1960. [PMID: 33775487 DOI: 10.1016/j.ejso.2021.03.244] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 03/07/2021] [Accepted: 03/14/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Carotid body tumors (CBTs) are rare head and neck neoplasms, we aimed to propose a modification to the Shamblin's classification of CBTs. MATERIALS AND METHODS This retrospective study included 105 patients (116 CBTs) operated at our institution from March 2013 to July 2020. CBTs were divided by a modified Shamblin's classification into five subtypes (type I-V) based on the radiographic features. Correlations between modified classification and intraoperative bleeding, internal carotid artery (ICA) bypass and postoperative neural complications, as main outcomes, as well as other outcomes were analyzed. RESULTS Surgeries for type V and type I CBTs had the most (median: 700 ml, IQR: 375-1575 ml) and least (median: 20 ml, IQR: 20-50 ml) bleeding, respectively. Intraoperatively, ICA bypass was needed in 41.7% (10/24) type V, 18.2% (8/44) type IV and 5.9% (1/17) type III lesions, but not in other subtypes (p = .001). Postoperatively, overall cranial nerve deficits (CND) were found most frequently in type V tumors (17/24, 70.8%) (p = .016). Permanent CND were found in 33.3% (8/24) type V and 4.5% (2/44) type IV lesions, but not in other subtypes (p = .001). Other outcomes including external carotid artery ligation, operation time, blood transfusion, postoperative intensive unit care and postoperative hospitalization also showed significant difference among different subtypes. Patients recovered uneventfully during a follow-up of 23.5 ± 16.2 months except for one ipsilateral recurrence at 42 months after surgery. CONCLUSIONS The modified classification was correlated with surgical outcomes of CBTs and will be helpful for making surgical plans.
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Affiliation(s)
- Guangchao Gu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Shuaifuyuan 1, Dongcheng District, Beijing, 100730, China
| | - Xiao Wu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Shuaifuyuan 1, Dongcheng District, Beijing, 100730, China
| | - Lei Ji
- Department of Vascular Surgery, Peking Union Medical College Hospital, Shuaifuyuan 1, Dongcheng District, Beijing, 100730, China
| | - Zhili Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Shuaifuyuan 1, Dongcheng District, Beijing, 100730, China
| | - Fangda Li
- Department of Vascular Surgery, Peking Union Medical College Hospital, Shuaifuyuan 1, Dongcheng District, Beijing, 100730, China
| | - Bao Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Shuaifuyuan 1, Dongcheng District, Beijing, 100730, China
| | - Changwei Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Shuaifuyuan 1, Dongcheng District, Beijing, 100730, China
| | - Wei Ye
- Department of Vascular Surgery, Peking Union Medical College Hospital, Shuaifuyuan 1, Dongcheng District, Beijing, 100730, China
| | - Yuexin Chen
- Department of Vascular Surgery, Peking Union Medical College Hospital, Shuaifuyuan 1, Dongcheng District, Beijing, 100730, China
| | - Jiang Shao
- Department of Vascular Surgery, Peking Union Medical College Hospital, Shuaifuyuan 1, Dongcheng District, Beijing, 100730, China
| | - Rong Zeng
- Department of Vascular Surgery, Peking Union Medical College Hospital, Shuaifuyuan 1, Dongcheng District, Beijing, 100730, China
| | - Xiaojun Song
- Department of Vascular Surgery, Peking Union Medical College Hospital, Shuaifuyuan 1, Dongcheng District, Beijing, 100730, China
| | - Heng Guan
- Department of Vascular Surgery, Peking Union Medical College Hospital, Shuaifuyuan 1, Dongcheng District, Beijing, 100730, China
| | - Yuehong Zheng
- Department of Vascular Surgery, Peking Union Medical College Hospital, Shuaifuyuan 1, Dongcheng District, Beijing, 100730, China.
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30
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Chen WL, Zhou B, Pan CB, Yuan KF, Zhong JL, Hong L. Comparison of 3 techniques of surgical treatment of carotid body tumors. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 131:643-649. [PMID: 33741281 DOI: 10.1016/j.oooo.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/09/2020] [Accepted: 01/04/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Carotid body tumors (CBTs) are benign but challenging. This study compared outcomes of 3 techniques of the surgical treatment of CBTs. STUDY DESIGN This retrospective observational study was conducted from April 2013 to March 2019. The 38 patients enrolled in the study had primary tumors, including 1 with bilateral tumors and another with adrenal gland pheochromocytoma. We collected data on age, sex, size of tumor, Shamblin classification, treatment, blood loss, operative time, hospital stay, complications, and recurrence. Statistical analyses were performed using IBM SPSS Statistics version 20 software. RESULTS Twenty-four patients were male, and 12 were female, and they ranged in age from 11 to 71 years. Cases were assigned to Shamblin groups I (n = 6), II (n = 19), and III (n = 14). Tumor size ranged from 2.0 × 2.0 cm to 5.0 × 6.0 cm. Eleven CBTs underwent blunt dissection (BD), 20 underwent BD plus resection of external carotid artery division plus vessels of encapsulation with allograft dermal matrix (BD + RECA + VE), and 8 tumors underwent surgical resection of tumors plus common carotid artery-internal carotid artery artificial vascular reconstruction (SR +C-IAVR). No perioperative death or stroke occurred. There was a significant difference between Shamblin groups I, II, and III in terms of the size of the tumor, type of treatment used, blood loss, operative time, hospital stay, and complications. Six patients had mandibular branch facial nerve transient paresis; 7 patients had hypoglossal nerve dysfunction; 3 patients had Horner syndrome; and dysphasia occurred in 2 patients. The patients were seen in follow-up for 16 to 45 months, and 1 recurrence was observed. CONCLUSIONS Three surgical techniques-BD, BD + RECA + VE, and SR + C-IAVR-are safe and feasible for the treatment of CBTs according to Shamblin classifications.
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Affiliation(s)
- Wei-Liang Chen
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University.
| | - Bin Zhou
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Chao-Bin Pan
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Kai-Fang Yuan
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Jiang-Long Zhong
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Lei Hong
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
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31
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Usman R, Jamil M, Aman A. Surgical Excision of Carotid Body Tumor at an Early Stage Has Best Outcome: Result of 22 Cases along with Literature Review. Ann Vasc Dis 2020; 13:365-369. [PMID: 33391552 PMCID: PMC7758592 DOI: 10.3400/avd.oa.20-00084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: The objective of this study is to share our experience of early surgical excision of highly vascular carotid body tumor (CBT) and to correlate it with current literature. Materials and Methods: Data of all consecutive patients diagnosed with CBT from September 2011 to September 2018, who underwent surgical excision, was analyzed. Results: Of the 22 cases with mean age of 42±standard deviation (SD) 6 years and female to male ratio of 1.2 : 1, 68.1% (n=15) of the tumors were on the right side. There were 13.6% (n=3) Shamblin I, 77.2% (n=17) Shamblin II, and 9% (n=2) Shamblin III tumors. Complete excision without vascular reconstruction was achieved in 63.6% (n=14), while patch plasty with Dacron graft was noted in 29.4% (n=5) and interposition Dacron grafting 13.6% (n=3). Peroperative vascular shunt was deployed in 13.6% (n=3) of cases. Transient neuropraxia of the hypoglossal nerve was noted in 13.6% (n=3) of cases, while permanent drooping of the lower lip was noted in 4.5% (n=1). There was no ischemic stroke. The mortality rate was zero, and no recurrence was recorded in mean follow-up of 24±SD 3 months. Conclusion: Complete surgical excision of CBT at an early stage, regardless of size, is associated with the best outcome.
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Affiliation(s)
- Rashid Usman
- Department of Vascular Surgery, Combined Military Hospital, Lahore Cantt, Pakistan
| | - Muhammad Jamil
- Department of Vascular Surgery, Combined Military Hospital, Rawalpindi Cantt, Pakistan
| | - Aaiza Aman
- Department of Surgery, Fauji Foundation Hospital, Rawalpindi, Pakistan
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Yang X, He XG, Jiang DH, Feng C, Nie R. Postoperative secondary aggravation of obstructive sleep apnea-hypopnea syndrome and hypoxemia with bilateral carotid body tumor: A case report. World J Clin Cases 2020; 8:6150-6157. [PMID: 33344617 PMCID: PMC7723711 DOI: 10.12998/wjcc.v8.i23.6150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/02/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Carotid body tumor (CBT) is a chemoreceptor tumor located in the carotid body, accounting for approximately 0.22% of head and neck tumors. Surgery is the main treatment method for the disease.
CASE SUMMARY We reviewed the diagnosis and treatment of one patient who had postoperative secondary aggravation of obstructive sleep apnea–hypopnea syndrome (OSAHS) and hypoxia after surgical resection of bilateral CBTs. This patient was admitted, and relevant laboratory and imaging examinations, and polysomnography (PSG) were performed. After the definitive diagnosis, continuous positive airway pressure (CPAP) treatment was given, which achieved good efficacy.
CONCLUSION This case suggested that aggravation of OSAHS and hypoxemia is possibly caused by the postoperative complications after bilateral CBTs, and diagnosis by PSG and CPAP treatment are helpful for this patient.
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Affiliation(s)
- Xi Yang
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| | - Xiao-Guang He
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| | - Dong-Hui Jiang
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| | - Chun Feng
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| | - Rui Nie
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
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Yang X, He XG, Jiang DH, Feng C, Nie R. Postoperative secondary aggravation of obstructive sleep apnea-hypopnea syndrome and hypoxemia with bilateral carotid body tumor: A case report. World J Clin Cases 2020. [DOI: 10.12998/wjcc.v8.i23.6143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Mohebali J, Edwards HA, Schwartz SI, Ergul EA, Deschler DG, LaMuraglia GM. Multispecialty surgical management of carotid body tumors in the modern era. J Vasc Surg 2020; 73:2036-2040. [PMID: 33253874 DOI: 10.1016/j.jvs.2020.10.072] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/18/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The objective of this study was to assess the perioperative and long-term outcomes of carotid body tumor (CBT) resection with a multispecialty (head and neck surgery/vascular surgery) approach. METHODS Our institutional data registry was queried for Current Procedural Terminology codes (60600, 60605) pertaining to CBT excision. These patient records and operative reports were individually reviewed to determine laterality, preoperative tumor embolization, operative time, estimated blood loss, need for intraoperative transfusion, intraoperative electroencephalogram changes, intraoperative division of the external carotid artery, carotid artery repair, resection of the carotid bifurcation, tumor volume, final pathology, cranial nerve injury, stroke, death, and clinical or radiographic evidence of recurrence. RESULTS From 1996 to 2018, 74 CBT resections were identified in 68 patients (41 [60%] females; mean age, 50.83 years). The mean tumor volume was 9.92 ± 14.26 cm3 (range, 0.0250-71.0627 cm3). Embolization was performed by a neurointerventional specialist in 27 CBT resections (36%) based on size (embolization 14.27 ± 16.84 cm3 vs 7.17 ± 11.86 cm3; P = .063) and superior extension. This practice resulted in one asymptomatic vertebral dissection, which postponed the surgery. There was a trend toward greater blood loss in the embolization group (embolization 437 ± 545 mL vs 262 ± 222 mL; P = .17); however, no transfusions were required in any patient. The mean operative time was also significantly longer in the embolization group (198.33 ± 61.13 minutes vs 161.5 ± 55.56 minutes; P = .03). Three resections had reversible intraoperative electroencephalogram changes, one of which occurred during carotid clamping. These changes resolved with shunting. Eight external carotid resections (11%) and 6 carotid reconstructions (8.1%; two primary, two patch, and two primary anastomosis) were required. Malignancy was identified in four tumors (5.4%), accounting for four of the six carotid reconstructions. There were no postoperative cranial nerve injuries, no strokes, no reexplorations, and no deaths. One patient developed transient dysphagia from pharyngeal tumor infiltration. Long-term follow-up (mean, 43 ± 54 months), available in 61 of the 68 patients (89.7%), revealed three (4.4%) recurrences. CONCLUSIONS This large, single-institution series demonstrates that a multispecialty team combining two surgical skill sets for the treatment of this rare, challenging condition yields unparalleled low complication rates with short operative times. This approach, including long-term surveillance for recurrent disease, should be considered to optimize outcomes of CBT resection.
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Affiliation(s)
- Jahan Mohebali
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Heather A Edwards
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Boston University School of Medicine, Boston, Mass
| | - Samuel I Schwartz
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Emel A Ergul
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Daniel G Deschler
- Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Mass
| | - Glenn M LaMuraglia
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
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Gözen ED, Tevetoğlu F, Kara S, Kızılkılıç O, Yener HM. Is Preoperative Embolization Necessary for Carotid Paraganglioma Resection: Experience of a Tertiary Center. EAR, NOSE & THROAT JOURNAL 2020; 101:NP180-NP185. [PMID: 32921153 DOI: 10.1177/0145561320957236] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE This study was designed to investigate whether preoperative embolization is a useful procedure to decrease blood loss and neurovascular complications for carotid body tumor (CBT) surgery or not. METHODS Medical records of our tertiary care center from 2012 to 2019 were scanned for patients who underwent surgery for CBT, retrospectively. Age, gender, complaint and head and neck examination findings at the time of presentation, preoperative complete blood count parameters, imaging records (cervical magnetic resonance imaging and carotid artery angiography), Shamblin classification, tumor size, intraoperative findings, and postoperative complications were noted. RESULTS A total of 26 patients were operated due to CBT between 2012 and 2019 in our clinic; preoperative arterial embolization was performed to 15 (57.7%) patients, and 11 (42.3%) patients were operated without embolization. Youngest patient was 24 years old, while oldest was 69 years and mean age was 44.35 ± 12.73. (embolization group: ages ranging between 24 and 64 with a mean of 41.5 ± 11.02 years; in nonembolization group: ages ranging between 26 and 69 with a mean of 48.1 ± 14.3). Embolization status was not significantly related to cranial nerve injury, vascular injury, overall complications, and hematocrit decrease. Arterial injury is more likely to occur with increasing Shamblin class (r = .39; P = .04). Tumor size is not found to be significantly related to cranial nerve injury, vascular injury, overall complications, and hematocrit decrease, but cranial nerve injury and vascular injury were more likely to occur in large tumors (r = .34; P = .089 and r = .34; P = .087, respectively). Age was significantly and negatively correlated to vascular injury (r = -.51; P = .05). Vascular injury was significantly correlated with gender (male predominance: r = -.64; P = .000). CONCLUSION Although preoperative arterial embolization is considered to attenuate the complication risk, we found that there was no significant difference among the patients with or without embolization.
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Affiliation(s)
- Emine Deniz Gözen
- Department of Otorhinolaryngology, 64298Istanbul University-Cerrahpasa Medical Faculty, Fatih, İstanbul, Turkey
| | - Fırat Tevetoğlu
- Department of Otorhinolaryngology, 64298Istanbul University-Cerrahpasa Medical Faculty, Fatih, İstanbul, Turkey
| | - Sinem Kara
- Department of Otorhinolaryngology, 64298Istanbul University-Cerrahpasa Medical Faculty, Fatih, İstanbul, Turkey
| | - Osman Kızılkılıç
- Department of Radiology, 532719Istanbul University-Cerrahpasa Medical Faculty, Fatih, İstanbul, Turkey
| | - Haydar Murat Yener
- Department of Otorhinolaryngology, 64298Istanbul University-Cerrahpasa Medical Faculty, Fatih, İstanbul, Turkey
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Lozano FS, Muñoz A, de Las Heras JA, González-Porras JR. Simple and complex carotid paragangliomas. Three decades of experience and literature review. Head Neck 2020; 42:3538-3550. [PMID: 32812684 DOI: 10.1002/hed.26421] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 06/01/2020] [Accepted: 07/28/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Carotid paragangliomas are rare tumors. They are usually unique, non-secreting, resectable, and benign. However, additional rare cases of complex tumors (bilateral, secretory, nonresectable, or malignant) complicate the management and final outcomes. METHODS Records of paragangliomas from our hospital are reviewed. Criteria defining complex paragangliomas have been previously defined. These are compared with those of the simple group. RESULTS Fifty patients, two groups: simple (n = 39) and complex (n = 11). The patients in the complex group were significantly younger (47.7 vs 63.8 years). Postoperative nerve complications (45.4% vs 6.3%) and mortality during follow-up (27.3% vs 0%) were significantly more common in the complex group. Vascular complications (0% vs 3.1%) and early mortality (0%) were similarly in both groups. CONCLUSIONS Patients with complex carotid paragangliomas are heterogeneous. The former are younger, exhibit a high degree of diagnostic and therapeutic complexity, and have poorer morbidity and mortality. Surgical experience and interdisciplinary collaboration are essential.
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Affiliation(s)
- Francisco S Lozano
- Department of Angiology and Vascular Surgery, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Angel Muñoz
- Department of Otorhinolaryngology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - José A de Las Heras
- Department of Radiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - José R González-Porras
- Department of Hematology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
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Alimohamad H, Yilmaz D, Hamming JF, Schepers A. Identifying Factors Influencing Decision Making in Patients Diagnosed with Carotid Body Tumors: An Exploratory Study. Ann Vasc Surg 2020; 68:159-165. [PMID: 32502676 DOI: 10.1016/j.avsg.2020.05.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/25/2020] [Accepted: 05/02/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Carotid body tumors (CBTs) are rare highly vascularized and slow enlarging tumors arising from the paraganglionic tissue at the carotid bifurcation. Main treatment options for CBTs are surgical resection or "wait and scan" strategy. The choice for either strategy may be equally good medically in many patients. A structured "shared decision making" (SDM) might be helpful for guiding patients. OBJECTIVES To develop an SDM strategy for the surgical treatment, we aim to (1) identify considerations and factors involved in the decision making of patients with CBTs and (2) evaluate the current practice in our clinic and explore the opinions of patients on their treatment. METHODS This exploratory study was conducted in patients of the Leiden University Medical Centre (LUMC), The Netherlands. Patients who met the inclusion criteria were invited for a semi-structured interview. All conversations were fully audiotaped and transcripted. RESULTS Fifteen patients were included and interviewed. Ten of these patients underwent previously surgical resection of at least one tumor. Five patients underwent the wait and scan policy. The most important factors influencing decision making in CBT treatment are family, fears, co-consultants, and doctor-patient relationship. CONCLUSIONS This study has identified the factors influencing decision making in CBT and should be considered during consultations. The decision for surgery or not was mainly influenced by physician preferences and family members' prior experiences.
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Affiliation(s)
- Hoda Alimohamad
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Dilek Yilmaz
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Jaap F Hamming
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Abbey Schepers
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands.
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Lloyd S, Obholzer R, Tysome J. British Skull Base Society Clinical Consensus Document on Management of Head and Neck Paragangliomas. Otolaryngol Head Neck Surg 2020; 163:400-409. [DOI: 10.1177/0194599820915490] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The management of head and neck paragangliomas (HNPGLs) has changed significantly in recent years. There is, however, an absence of guidance in the literature regarding the optimal means of managing this challenging disease. This consensus document, developed by the British Skull Base Society, sets out recommendations for management of HNPGLs. A preliminary document was produced on the basis of current practice in 3 large UK skull base centers, incorporating relevant peer-reviewed evidence. This document was then modified by discussion within these units, through a national survey of British Skull Base Society members, and through discussion with stakeholders. A consensus was reached on the management of all forms of HNPGL. All patients should be managed by a multidisciplinary team and require initial surgical, endocrine, and genetic assessments as well as magnetic resonance imaging of the head, neck, chest, abdomen, and pelvis. Long-term preservation of function is the primary treatment goal, with conservative management the first choice treatment for most tumors. Radiotherapy is a safe, effective treatment for growing tumors in most cases, although there is a limited role for surgery. Screening of family members in high-risk groups is mandatory. These guidelines should help standardize high-quality care for patients with HNPGLs.
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Affiliation(s)
- Simon Lloyd
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Department of Otolaryngology Head and Neck Surgery, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Manchester Skull Base Unit, Salford Royal Hospital, Manchester, UK
| | - Rupert Obholzer
- Department of Otolaryngology Head and Neck Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Department of Neurosurgery, National Hospital For Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - James Tysome
- Department of Otolaryngology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Cambridge Ear Institute, University of Cambridge, Cambridge, UK
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Sevil FC. Management and outcomes of vascular reconstruction in carotid body tumor resection: retrospective analysis of 60 cases. Eur Arch Otorhinolaryngol 2020; 277:2299-2306. [PMID: 32335710 DOI: 10.1007/s00405-020-05975-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/09/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Carotid body tumors (CBTs) are rare tumors of the head and neck area. We evaluated outcomes after carotid body tumor resection (CBR) requiring vascular reconstruction. METHODS We retrospectively reviewed the patients, who underwent CBR in our clinic. Medical records were retrospectively reviewed for clinical data, operative details, Shamblin's classification, complications. Comparisons were performed between those undergoing CBR alone and CBR requiring vascular reconstruction (CBR-VASC). RESULTS Of the 60 patients, who underwent CBR, 29 (48.3%) underwent vascular reconstruction after the tumor resection. In patients; who underwent carotid endarterectomy and reconstruction of a kinked carotid artery, the blood flow measurements obtained before and after the vascular reconstruction were significantly different. The blood flow measurement parameters obtained before and after the vascular reconstruction were not significantly different in patients undergoing primary repair surgery, patch graft angioplasty, and the use of reversed saphenous vein graft procedures. The overall complication rate was 25% (n = 60) for at least one perioperative problem (CBR 6.4% vs. CBR-VASC 44.8%, p > 0.05). While most patients with Shamblin's class I and II tumors underwent CBR, CBR-VASC was performed more frequently in patients with Shamblin's class III tumors (p = 0.016). The tumor size ( p = 0.016), the volume of intraoperative blood loss (p = 0.002), and the length of hospital stay (p = 0.006) were significantly different between the two groups. The length of the operation time (p = 0.154) and the volume of the postoperative blood drainage (p = 0.122) were not different between the two groups. CONCLUSION The decision for surgical reconstruction should be made by evaluating the carotid artery blood flow before and after CBR. The type of the reconstruction method does not cause differences in the duration of the surgery and does not elevate the complication rates.
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Affiliation(s)
- Fehim Can Sevil
- Department of Cardiovascular Surgery, Afyonkarahisar Health Sciences University Hospital, Afyonkarahisar, Turkey.
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Melachuri S, Valappil B, Snyderman C. Variations in Surgical Outcomes of Carotid Body Tumors by Surgical Specialty. Laryngoscope 2020; 131:E190-E195. [PMID: 32311766 DOI: 10.1002/lary.28688] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES/HYPOTHESIS A carotid body tumor (CBT) is a rare type of tumor that is divided among multiple surgical specialties. Individual surgeons may have limited experience in treating these tumors. We aim to compare different surgical specialties within a single healthcare system to detect variations in management and outcome. STUDY DESIGN Retrospective chart review. METHODS A chart review of all patients who underwent surgery for CBT at the University of Pittsburgh Medical Center (UPMC) from 2000 to 2019 was carried out. Univariate and multivariate analysis was used for descriptive statistics, comparison of outcomes, and identification of risk factors. RESULTS Fifty-eight CBT resection surgeries were performed at UPMC. Patients with advanced tumor were 6.7 (95% confidence interval [CI]: 1.36-32.7) times more likely to undergo preoperative embolization and 8.53 (95% CI: 2.011-36.19) times more likely to sustain carotid artery injury. Advanced-stage tumor resections were associated with greater blood loss (P = .03) and longer hospitalization (P = .02). Collaborative surgeries were associated with higher rates of carotid artery injury (P = .003), residual tumor (P < .001), and longer hospitalization (P = .003), as these combined cases were generally reserved for advanced-stage tumors (P = .02). There were no differences in outcomes between specialties. Of 22 surgeons, the median number of surgeries per surgeon was one (range = 1-12, 54.5%). CONCLUSIONS Surgeons who completed only one surgery for CBT had a greater rate of hospital readmission and greater length of hospital stay. Collaborative surgeries had worse outcomes due to more advanced tumors requiring more complex surgeries. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E190-E195, 2021.
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Affiliation(s)
- Samyuktha Melachuri
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Benita Valappil
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
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Mascia D, Esposito G, Ferrante A, Grandi A, Melissano G, Chiesa R. Carotid body tumor contemporary management in a high-volume center. THE JOURNAL OF CARDIOVASCULAR SURGERY 2019; 61:459-466. [PMID: 31599140 DOI: 10.23736/s0021-9509.19.10496-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study is to report our results with carotid body tumor (CBT) surgical management. METHODS Between 2010 and 2018, 100 CBTs (mean age: 48.0 years, range 21-80 years old) were treated in our center. The patients were classified in 3 groups according to the size: group I (<3 cm), group II (3 to 5 cm) and group III (>5 cm). RESULTS Surgical resection was performed in 88 patients and conservative treatment in 2 cases. Nine patients were treated for bilateral involvement and one of them was also treated again for a relapse. Postoperatively, cranial nerve injury (CNI) was significantly higher in group II [3 (8.3%) vs. 16 (31.4%) vs. 2 (15.4%); P=0.030] with no statistical differences between the CN involved. At univariate analysis for CNI, CBT group (P=0.030), maximum diameter (P=0.046), patients presenting with dysphonia (P=0.035) and dysphagia (P=0.007) and patients suffering from any intraoperative complication (P=0.047) were statistically significant. At multivariate analysis the only significant variable was CBT group II (P=0.016). For blood loss, CBT group III (P<0.001), Shamblin class III (P<0.001), Pulmonary disease (P=0.034) and surgery time (P<0.001) were statistically significant. The follow-up of 79 patients (87.8%) showed a 100% overall survival at median follow-up of 37.7 months (range 2-84.7 months) with freedom from local recurrence of 97.8% (77/79). CONCLUSIONS Surgical resection remains the gold standard to obtain complete recovery, although tumor size is to be considered a risk factor for CNI because large CBTs remain at high risk for CNIs.
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Affiliation(s)
- Daniele Mascia
- Unit of Vascular Surgery, San Raffaele Hospital IRCCS, Vita-Salute San Raffaele University, Milan, Italy -
| | - Gloria Esposito
- Unit of Vascular Surgery, San Raffaele Hospital IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Angela Ferrante
- Unit of Vascular Surgery, A. Gemelli University Polyclinic, Sacred Heart Catholic University, Rome, Italy
| | - Alessandro Grandi
- Unit of Vascular Surgery, San Raffaele Hospital IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Germano Melissano
- Unit of Vascular Surgery, San Raffaele Hospital IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Chiesa
- Unit of Vascular Surgery, San Raffaele Hospital IRCCS, Vita-Salute San Raffaele University, Milan, Italy
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Texakalidis P, Charisis N, Giannopoulos S, Xenos D, Rangel-Castilla L, Tassiopoulos AK, Jabbour P, Grossberg JA, Machinis T. Role of Preoperative Embolization in Carotid Body Tumor Surgery: A Systematic Review and Meta-Analysis. World Neurosurg 2019; 129:503-513.e2. [DOI: 10.1016/j.wneu.2019.05.209] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/24/2019] [Accepted: 05/25/2019] [Indexed: 10/26/2022]
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Schneider R, Elwerr M, Lorenz K, Plontke S, Dralle H, Ukkat J. [Surgical treatment options for cervical paragangliomas]. Chirurg 2019; 90:29-36. [PMID: 30242437 DOI: 10.1007/s00104-018-0734-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The therapies available for the rare tumor entity of cervical paraganglioma (PG) are currently undergoing a paradigm shift. The treatment of choice for small carotid body tumors, malignant and active endocrine tumors is surgical resection; however, for locally advanced carotid body tumors and vagal PG, surgical therapy should be critically evaluated. Due to the immediate proximity of these hypervascularized tumors to the caudal cranial nerves, there is a risk of severe nerve damage with a significant impairment of quality of life after resection, particularly for locally advanced cervical PG, emphasizing further the importance of a restrictive surgical strategy. External radiotherapy can provide an equivalent primary therapeutic option with respect to the rate of recurrence and is accompanied by a lower morbidity. The slow rate of tumor progression and the multifocality of the familial variant of cervical PG or significant comorbidities in older, asymptomatic patients warrant a less aggressive treatment strategy for these tumors. When a wait and scan approach is implemented, a closely monitored radiological and clinical re-evaluation is of upmost importance. In a multidisciplinary approach the following critical points require consideration before a therapy is implemented,: size and location of the tumor, progression rate, genetic background, patient age and general condition, relevant comorbidities, the presence of synchronous PG and/or vasoactive catecholamine-producing tumors. Although best practice algorithms for the treatment of cervical PG have already been devised, recent innovative developments have led to more patient-tailored, individualized treatment approaches.
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Affiliation(s)
- R Schneider
- Universitätsklinik und Poliklinik für Viszerale, Gefäß und Endokrine Chirurgie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle/Saale, Deutschland.
| | - M Elwerr
- Universitätsklinik und Poliklinik für Viszerale, Gefäß und Endokrine Chirurgie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle/Saale, Deutschland
| | - K Lorenz
- Universitätsklinik und Poliklinik für Viszerale, Gefäß und Endokrine Chirurgie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle/Saale, Deutschland
| | - S Plontke
- Universitätsklinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Halschirurgie, Martin-Luther-Universität, Halle/Saale, Deutschland
| | - H Dralle
- Sektion Endokrine Chirurgie, Klinik für Allgemeinchirurgie, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - J Ukkat
- Universitätsklinik und Poliklinik für Viszerale, Gefäß und Endokrine Chirurgie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle/Saale, Deutschland
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Robertson V, Poli F, Hobson B, Saratzis A, Ross Naylor A. A Systematic Review and Meta-Analysis of the Presentation and Surgical Management of Patients With Carotid Body Tumours. Eur J Vasc Endovasc Surg 2019; 57:477-486. [PMID: 30902606 DOI: 10.1016/j.ejvs.2018.10.038] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/31/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The aim was to determine the mode of presentation and 30 day procedural risks in 4418 patients with 4743 carotid body tumours (CBTs) undergoing surgical excision. METHODS This is a systematic review and meta-analysis of 104 observational studies. RESULTS Overall, 4418 patients with 4743 CBTs were identified. The mean age was 47 years, with the majority being female (65%). The commonest presentation was a neck mass (75%), of which 85% were painless. Dysphagia, cranial nerve injury (CNI), and headache were present in 3%, while virtually no one presented with a transient ischaemic attack (0.26%) or stroke (0.09%). The majority (97%) underwent excision, but only 21% underwent pre-operative embolisation. Overall, 27% were Shamblin I CBTs; 44% were Shamblin II; and 29% were Shamblin III. The mean 30 day mortality was 2.29% (95% CI 1.79-2.93). The mean 30 day stroke rate was 3.53% (95% CI 2.91-4.29), while the mean 30 day CNI rate was 25.4% (95% CI 24.5-31.22). The prevalence of persisting CNI at 30 days was 11.15% (95% CI 8.42-14.64). Twelve series (544 patients) correlated 30 day stroke with Shamblin status. Shamblin I CBTs were associated with a 1.89% stroke rate (95% CI 0.92-3.82), increasing to 2.71% (95% CI 1.43-5.07) for Shamblin II CBTs and 3.99% (95% CI 2.34-6.74) for Shamblin III tumours. Twenty-six series (1075 patients) correlated CNI rates with Shamblin status: 3.76% (95% CI 2.62-5.35) for Shamblin I CBTs, 14.14% (95% CI 11.94-16.68) for Shamblin II, and 17.10% (95% CI 14.82-19.65) for Shamblin III tumours. The prevalence of neck haematoma requiring re-exploration was 5.24% (95% CI 3.45-7.91). The proportion of patients with a neck haematoma requiring re-exploration was not reduced by pre-operative embolisation (5.92%; 95% CI 2.56-13.08) vs. no embolisation (5.82%; 95% CI 2.76-11.88). Pre-operative embolisation did not reduce drainage losses (639 mL vs. 653 mL). CONCLUSIONS This is the largest meta-analysis of outcomes after CBT excision. Procedural risks associated with tumour excision were considerable, especially with Shamblin III tumours where 4% suffered a peri-operative stroke and 17% suffered a CNI.
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Affiliation(s)
- Vaux Robertson
- The Leicester Vascular Institute, Glenfield Hospital, Leicester UK
| | - Federica Poli
- The Leicester Vascular Institute, Glenfield Hospital, Leicester UK
| | - Ben Hobson
- The Leicester Vascular Institute, Glenfield Hospital, Leicester UK
| | | | - A Ross Naylor
- The Leicester Vascular Institute, Glenfield Hospital, Leicester UK.
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Abstract
Carotid body paraganglioma (CBP) is a type neuroendocrine tumour arising from paraganglial chief cells of carotid body. Situated at the bifurcation of the common carotid artery, it constitutes 0.5% of all body tumours. Though CBP's is most common paraganglioma of head and neck it is a rare neoplasm and requires a thorough examination for a proper diagnosis and therapeutic management. Here, we present a case of 36 year old female patient with CBP in left side of the neck.
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Affiliation(s)
| | - Jayesh S Khivasara
- Department of Head and Neck Oncology, Mahatma Gandhi Cancer Hospital, Sangli, Maharashtra, India
| | - Niharika Swain
- Department of Oral Pathology and Microbiology, MGM DCH, Navi Mumbai, Maharashtra, India
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The Outcome of Multidisciplinary Management of Carotid Body Tumors: Retrospective Cohort Study. J Maxillofac Oral Surg 2018; 18:610-616. [PMID: 31624445 DOI: 10.1007/s12663-018-1176-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 11/22/2018] [Indexed: 10/27/2022] Open
Abstract
Background Carotid body tumor (CBT) is a rare paraganglionic hyper-vascular tumor of the carotid body. The standard treatment for CBTs is surgery, but it involves risk. The study is aimed to assess the CBTs and evaluate the outcome of multidisciplinary management. Materials and Methods A retrospective cohort study included patients with CBTs who were managed by surgical excision between May 2006 and April 2018. A multidisciplinary team was established to excise the tumor completely with minimal neurovascular compromise. Results The study comprised of 32 patients in the age group of 23-65 years. The main presentation was a unilateral painless neck mass. Six cases (18.75%) were Shamblin I, 10 (31.25%) Shamblin II and 16 (50%) Shamblin III. Complete excision was performed for all cases. Ligation of the external carotid artery was done in 15 cases (46.88%) and repair of the internal carotid artery in 6 (18.75%). Postoperative cranial nerve complications occurred in six patients (18.75%): four transient hypoglossal pareses and two hoarseness of voice. Histopathologically, one case (3.125%) was malignant. No recurrence was detected through the follow-up period. Conclusion A multidisciplinary approach is essential for management of CBTs. Early diagnosis and surgical resection minimize morbidity and carry good surgical outcome. Trial Registration Number ChiCTR1800018722 (Agency: Chinese Clinical Trial Registry).
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Janakiram TN, Nadakkavukaran J, Bhatia Sharma S, Sathyanarayanan JD. A Hybrid Approach Towards Successful Resection of a Huge Carotid Body Paraganglioma Using Coil Embolization and Traditional Surgical Techniques. Indian J Otolaryngol Head Neck Surg 2018; 71:136-139. [PMID: 30906731 DOI: 10.1007/s12070-018-1516-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 10/20/2018] [Indexed: 11/25/2022] Open
Abstract
Carotid Body Paraganglioma (CBPGL), is a type of neuroendocrine tumor that should be managed promptly due to their malignant potential and locally aggressive nature making resection at a later stage difficult. The objective of this case report is to explore the benefit of coil embolization and describe the surgical techniques employed in successful resection of a huge CBPGL.
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Affiliation(s)
- T N Janakiram
- Royal Pearl Hospital Trichy, 3rd Cross Rd, Thillai Nagar East, Thillai Nagar, Tiruchchirappalli, Tamil Nadu 620018 India
| | - Joseph Nadakkavukaran
- Royal Pearl Hospital Trichy, 3rd Cross Rd, Thillai Nagar East, Thillai Nagar, Tiruchchirappalli, Tamil Nadu 620018 India
| | - Shilpee Bhatia Sharma
- Royal Pearl Hospital Trichy, 3rd Cross Rd, Thillai Nagar East, Thillai Nagar, Tiruchchirappalli, Tamil Nadu 620018 India
| | - J D Sathyanarayanan
- 2Meenakshi Medical College Hospital And Research Institute, Enathur, Karrapettai Post, Kanchipuram, Tamil Nadu 631552 India
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Usefulness of preoperative three-dimensional volumetric analysis of carotid body tumors. Neuroradiology 2018; 60:1281-1286. [DOI: 10.1007/s00234-018-2095-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/30/2018] [Indexed: 10/28/2022]
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Munakomi S, Chaudhary S, Cherian I. Case Report: Managing a giant, high-grade carotid body tumor in a resource-limited setting. F1000Res 2017; 6:1801. [PMID: 29259765 PMCID: PMC5717474 DOI: 10.12688/f1000research.12726.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2017] [Indexed: 11/20/2022] Open
Abstract
Herein we report the management of a giant, high-grade and vascular carotid body tumor in a young woman. She presented with slowly progressive neck swelling. Vascular imaging revealed a left-sided, high-grade giant carotid body tumor (> 8cm). The tumor was completely excised by caudocranial subadventitial dissection. Histology of the tumor revealed a characteristic Zellballen pattern of the lesion, suggestive of a paraganglioma. The patient made an uneventful recovery. We also discuss newer insights regarding the management of such highly vascular lesions.
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Affiliation(s)
- Sunil Munakomi
- Department of Neurosurgery, Nobel Teaching Hospital, Biratnagar, Nepal
| | - Samrita Chaudhary
- Department of Neurosurgery, Nobel Teaching Hospital, Biratnagar, Nepal
| | - Iype Cherian
- Department of Neurosurgery, Nobel Teaching Hospital, Biratnagar, Nepal
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Kim GY, Lawrence PF, Moridzadeh RS, Zimmerman K, Munoz A, Luna-Ortiz K, Oderich GS, de Francisco J, Ospina J, Huertas S, de Souza LR, Bower TC, Farley S, Gelabert HA, Kret MR, Harris EJ, De Caridi G, Spinelli F, Smeds MR, Liapis CD, Kakisis J, Papapetrou AP, Debus ES, Behrendt CA, Kleinspehn E, Horton JD, Mussa FF, Cheng SWK, Morasch MD, Rasheed K, Bennett ME, Bismuth J, Lumsden AB, Abularrage CJ, Farber A. New predictors of complications in carotid body tumor resection. J Vasc Surg 2017; 65:1673-1679. [PMID: 28527929 DOI: 10.1016/j.jvs.2016.12.124] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 12/10/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study examined the relationship between two new variables, tumor distance to base of skull (DTBOS) and tumor volume, with complications of carotid body tumor (CBT) resection, including bleeding and cranial nerve injury. METHODS Patients who underwent CBT resection between 2004 and 2014 were studied using a standardized, multi-institutional database. Demographic, perioperative, and outcomes data were collected. CBT measurements were determined from computed tomography, magnetic resonance imaging, and ultrasound examination. RESULTS There were 356 CBTs resected in 332 patients (mean age, 51 years; 72% female); 32% were classified as Shamblin I, 43% as Shamblin II, and 23% as Shamblin III. The mean DTBOS was 3.3 cm (standard deviation [SD], 2.1; range, 0-10), and the mean tumor volume was 209.7 cm3 (SD, 266.7; range, 1.1-1642.0 cm3). The mean estimated blood loss (EBL) was 257 mL (SD, 426; range, 0-3500 mL). Twenty-four percent of patients had cranial nerve injuries. The most common cranial nerves injured were the hypoglossal (10%), vagus (11%), and superior laryngeal (5%) nerves. Both Shamblin grade and DTBOS were statistically significantly correlated with EBL of surgery and cranial nerve injuries, whereas tumor volume was statistically significantly correlated with EBL. The logistic model for predicting blood loss and cranial nerve injury with all three variables-Shamblin, DTBOS, and volume (R2 = 0.171, 0.221, respectively)-was superior to a model with Shamblin alone (R2 = 0.043, 0.091, respectively). After adjusting for Shamblin grade and volume, every 1-cm decrease in DTBOS was associated with 1.8 times increase in risk of >250 mL of blood loss (95% confidence interval, 1.25-2.55) and 1.5 times increased risk of cranial nerve injury (95% confidence interval, 1.19-1.92). CONCLUSIONS This large study of CBTs demonstrates the value of preoperatively determining tumor dimensions and how far the tumor is located from the base of the skull. DTBOS and tumor volume, when used in combination with the Shamblin grade, better predict bleeding and cranial nerve injury risk. Furthermore, surgical resection before expansion toward the base of the skull reduces complications as every 1-cm decrease in the distance to the skull base results in 1.8 times increase in >250 mL of blood loss and 1.5 times increased risk of cranial nerve injury.
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Affiliation(s)
- Gloria Y Kim
- University of Michigan Health System, Ann Arbor, Mich; UCLA Health System, Los Angeles, Calif
| | | | - Rameen S Moridzadeh
- UCLA Health System, Los Angeles, Calif; NYU Langone Medical Center, New York, NY
| | | | | | | | | | | | | | | | | | | | | | | | - Marcus R Kret
- Colorado Cardiovascular Surgical Associates, Denver, Colo
| | - E John Harris
- Stanford University School of Medicine, Stanford, Calif
| | | | | | - Matthew R Smeds
- University of Arkansas for Medical Sciences, Little Rock, Ark
| | | | | | | | - Eike S Debus
- University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Joshua D Horton
- NYU Langone Medical Center, New York, NY; Medical University of South Carolina, Charleston, SC
| | - Firas F Mussa
- NYU Langone Medical Center, New York, NY; Columbia University, New York, NY
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