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Yildirim M, Yildirim H, Doğan Y. The effect of preoperative embolization rate on surgical outcomes for carotid paraganglioma resection. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20240371. [PMID: 39166682 PMCID: PMC11329243 DOI: 10.1590/1806-9282.20240371] [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: 03/12/2024] [Accepted: 05/27/2024] [Indexed: 08/23/2024]
Abstract
OBJECTIVE Preoperative embolization of paragangliomas decreases tumor volume and reduces intraoperative blood loss. This study aimed to evaluate the effect of the rate of devascularization achieved by preoperative embolization of carotid body tumors on surgical outcomes. METHODS Patients with carotid body tumors who underwent preoperative transarterial embolization between 2013 and 2024 were included in this retrospective study. The Shamblin classification of all patients was carried out using radiological imaging. Devascularization rates obtained after the embolization of carotid body tumors were determined from angiographic images. Patients were divided into two groups: near-complete embolization (devascularization rate >90%) and incomplete embolization (devascularization rate <90%). Hemoglobin loss was calculated with blood tests before and immediately after surgery. Tumor volume loss was calculated by preoperative radiological tumor volume and postoperative surgical specimen volume. Hemoglobin loss, tumor volume loss, and postoperative complication rates of the two groups were compared. RESULTS A total of 31 patients with carotid body tumors who underwent surgery were included in the study. Near-complete embolization was achieved in 21 patients (67.74%), while incomplete embolization was achieved in 10 patients (32.25%). Shamblin classification was statistically similar (p>0.05) between the two groups. The vascular complication rate in the near-complete embolization group was significantly lower than in the incomplete embolization group (p=0.027). However, no significant difference was observed in neurological complication rates, hemoglobin loss, and tumor volume loss parameters between the two groups (p>0.05). CONCLUSION The preoperative devascularization rate should be at least 90% to minimize the risk of vascular complications.
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Affiliation(s)
- Mustafa Yildirim
- Fırat University, Faculty of Medicine, Department of Radiology – Elâzığ, Turkey
| | - Hanefi Yildirim
- Fırat University, Faculty of Medicine, Department of Radiology – Elâzığ, Turkey
| | - Yusuf Doğan
- Fırat University, Faculty of Medicine, Department of Radiology – Elâzığ, Turkey
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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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Ozawa H. Current management of carotid body tumors. Auris Nasus Larynx 2024; 51:501-506. [PMID: 38522353 DOI: 10.1016/j.anl.2024.01.007] [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: 11/28/2023] [Revised: 01/03/2024] [Accepted: 01/23/2024] [Indexed: 03/26/2024]
Abstract
Carotid body tumors (CBTs) are neoplasms that occur at the bifurcation of the carotid artery and are pathologically classified as paragangliomas. In the 4th edition of the WHO classification, paragangliomas are categorized as neoplasms with malignant potential. Clinically, about 5% of CBTs present with malignant features such as metastasis. Currently, it is challenging to distinguish between tumors with benign courses and those that present malignantly. Recent advances in genetic testing have elucidated the genetic characteristics of paragangliomas, including carotid body tumors. Over 20 genes have been identified as being involved in tumor development. Particularly in head and neck paragangliomas, abnormalities in genes related to succinate dehydrogenase are frequently observed. Research is ongoing to understand the mechanisms by which these genes contribute to tumor development. The definitive treatment for CBTs is surgical resection. These tumors are prone to bleeding and often adhere firmly to the carotid artery, making intraoperative bleeding control challenging. The risk of lower cranial nerve paralysis is relatively high, and there is a risk of stroke because of manipulation of the carotid artery. Preoperative evaluation with angiography is essential, and a multi-disciplinary surgical team approach is necessary. In cases where the tumor is difficult to resect or has metastasized, radiation therapy or chemotherapy are employed. Clinical trials involving targeted molecular therapies and radiopharmaceuticals have recently been conducted, with some applied clinically. The development of various new treatments is anticipated, providing hope for therapeutic options in refractory cases.
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Affiliation(s)
- Hiroyuki Ozawa
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
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Bagheri-Hagh A, Saidi M, Yousefi J, Karimi E, Heidari F. Our Experience in Subadventitial Dissection vs. Intracapsular Dissection Technique of Carotid Body Tumors Surgery. Indian J Otolaryngol Head Neck Surg 2024; 76:2162-2165. [PMID: 38566715 PMCID: PMC10982139 DOI: 10.1007/s12070-023-04463-0] [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: 11/10/2023] [Accepted: 12/21/2023] [Indexed: 04/04/2024] Open
Abstract
This study provides a single-center experience involving intracapsular dissection for Shamblin II carotid body tumors (CBTs) and compares the outcomes with the classic technique of subadventitial resection. Based on the preliminary results, it seems that the enucleation technique facilitates the dissection of carotid body tumors, offering protection to cranial nerves and the internal/external/common carotid artery by utilizing the capsule as a barrier. The classic subadventitial resection approach and the enucleation technique have comparable postoperative complications. However, it is crucial to continue following the patients who underwent these resection techniques to determine the long-term outcomes. Moreover, the enucleation technique significantly reduces surgery duration and intraoperative blood loss.
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Affiliation(s)
- Ali Bagheri-Hagh
- New Hearing Technologies Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Department of ENT, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Masume Saidi
- New Hearing Technologies Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Department of ENT, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Jaleh Yousefi
- New Hearing Technologies Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Department of ENT, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ebrahim Karimi
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farrokh Heidari
- New Hearing Technologies Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Otorhinolaryngology Research Center, Amir Alam Hospital, North Sadi Ave, Tehran, 1145765111 Iran
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Piazza C, Lancini D, Tomasoni M, Zafereo M, Poorten VV, Hanna E, Mäkitie AA, Fernandez-Alvarez V, Kowalski LP, Chiesa-Estomba C, Ferlito A. Malignant carotid body tumors: What we know, what we do, and what we need to achieve. A systematic review of the literature. Head Neck 2024; 46:672-687. [PMID: 38179805 DOI: 10.1002/hed.27624] [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: 11/04/2023] [Revised: 12/10/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024] Open
Abstract
Malignant carotid body tumors (MCBT) are rare and diagnosed after detection of nodal or distant metastases. This systematic review (SR) focuses on MCBT initially approached by surgery. Preferred Reporting Items for SR and Meta-Analysis (MA) guided the articles search from 2000 to 2023 on PubMed, Scopus, and Web of Science. Among 3548 papers, 132 (337 patients) were considered for SR; of these, 20 (158 patients) for MA. Malignancy rate was 7.3%, succinate dehydrogenase (SDH) mutation 17%, age at diagnosis between 4th and 6th decades, with a higher prevalence of females. MCBTs were mostly Shamblin III, with nodal and distant metastasis in 79.7% and 44.7%, respectively. Malignancy should be suspected if CBT >4 cm, Shamblin III, painful or otherwise symptomatic, at the extremes of age, bilateral, with multifocal disease, and SDHx mutations. Levels II-III clearance should be performed to exclude nodal metastases and adjuvant treatments considered on a case-by-case basis.
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Affiliation(s)
- Cesare Piazza
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Davide Lancini
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Michele Tomasoni
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Mark Zafereo
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas, USA
| | - Vincent Vander Poorten
- Otorhinolaryngology - Head and Neck Surgery, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Ehab Hanna
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas, USA
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, Research Program in Systems Oncology, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Veronica Fernandez-Alvarez
- Department of Vascular and Endovascular Surgery, Hospital Universitario de Torrecardenas, Almeria, Spain
| | - Luiz P Kowalski
- Department of Head and Neck Surgery, University of Sao Paulo Medical School and Department of Head and Neck Surgery and Otorhinolaryngology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - Carlos Chiesa-Estomba
- Department of Otorhinolaryngology - Head and Neck Surgery, Donostia University Hospital, Deusto University - School of Medicine, BioGuipuzcoa Research Institute, San Sebastian, Spain
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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Rajendran S, Yadev IP, Sreekumar R. Preoperative Embolization in Surgical Resection of Cervical Paragangliomas: Usefulness and Current Evidence. Cureus 2023; 15:e48278. [PMID: 38058316 PMCID: PMC10695852 DOI: 10.7759/cureus.48278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Cervical paragangliomas (CPG) are slow-growing tumours, most of which are highly vascular, making surgical resection challenging. Preoperative embolisation of afferent arteries has been recommended to facilitate operative dissection, reduce perioperative blood loss, and shorten the duration of the operation. However, there is conflicting evidence on the benefits of preoperative embolisation on surgical outcomes, operative time, and bleeding. OBJECTIVES The objective of this study was to compare the perioperative parameters and outcomes like duration of surgery, blood transfusion, duration of stay in the ICU, cranial nerve injuries, and postoperative stroke between patients who underwent excision of CPGs with and without preoperative embolisation. METHODS This is a retrospective study conducted at the Division of Vascular Surgery, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, Kerala, India. The study included a review of the medical records of 32 patients who underwent excision of CPGs. Patients who underwent surgical resection without preoperative embolisation (SR) were compared with those who underwent surgical resection with embolisation (SREMB). Statistical analysis was done in R statistical software (R Foundation for Statistical Computing, Vienna, Austria). Categorical variables were reported in absolute numbers and percentages continuous variables were compared with an unpaired Mann-Whitney U test. The chi-square test was used to compare the categorical data. RESULTS Out of 32 patients included in this study, 13 (40.6%) patients were included in the SREMB group. Between the two groups, there were no significant differences in operative time (120 vs. 150 minutes; p = 0.59), blood transfusion requirement (0.69 vs. 0.37 units; p = 0.39) and ICU stays (1 vs. 1; p = 0.56). Postoperative cranial nerve injury was significantly more in the SREMB group (6 vs 1; p = 0.01) but stroke (0 vs 2; p = 0.50) was not statistically significant between the two groups. CONCLUSION In this study, we found that there was insufficient evidence to support routine preoperative embolisation in CPG. Hence, preoperative embolisation should only be used in a very select group of patients.
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Affiliation(s)
| | - I P Yadev
- General Surgery, Government Medical College, Thiruvananthapuram, Thiruvananthapuram, IND
| | - Ramachandran Sreekumar
- General Surgery, Government Medical College, Thiruvanthapuram, Thiruvananthapuram, IND
- Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, IND
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Gonzalez-Urquijo M, Hinojosa-Gonzalez DE, Viteri-Pérez VH, Becerril-Gaitan A, González-González M, Fabiani MA, Soto Vaca Guzmán IW, Valda Ameller GE, García-Pérez JDJ, Vaquero-Puerta C, Jaramillo-Vergara VH, Cisneros-Tinoco MA, Santoscoy-Ibarra JM, Cárdenas Figueroa EG, Borja Rojas VE, Salinas Ramos IV, Gonzalez-Valladares AJ, Katherine Perez AC, Bañuelos-Gutierrez G, Garcia Palafox JI, Gardeazabal-Diaz GF, López Aldayuz CA, Barajas-Colón JÁ. Risk Factors for Stroke After Carotid Paraganglioma Surgery. Ann Vasc Surg 2023; 90:137-143. [PMID: 36435423 DOI: 10.1016/j.avsg.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/26/2022] [Accepted: 10/14/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The Carotid Paraganglioma Cooperative International Registry (CAPACITY) is an international registry composed of 1,432 patients with carotid body tumors (CBT) from 11 centers from 4 countries. The aim of this study was to identify risk factors for patients who presented stroke after carotid paraganglioma resection. METHODS Clinical characteristics and demographics of patients who presented transoperatively and postoperatively stroke from the CAPACITY database were retrospectively gathered. Regression analysis was performed using single logistic regression with Omnibus' test for possible factors that might contribute to present stroke. RESULTS Out of 1,432 patients, 8 (0.5%) female patients presented stroke. Median age was 53 years (range: 41-70 years). Six strokes occurred transoperatively, diagnosed clinically in the immediate postoperative period. Of them, none of the patients received any further treatment. Three of them died on postoperative day 2, 3, and 4. Two patients developed stroke during the first 24 postoperative hours, patients showed dysarthria, and aphasia. One of them was reintervened with thrombectomy due to thrombosis of the common carotid artery the other patient was treated conservatively. Median follow-up was 16 months (range: 2-72 months). Single logistic regression analysis revealed a history of diabetes mellitus (odds ratio (OR) 7.62), carotid artery disease (OR 17.51), and vascular lesion (OR 2.37) to have significantly increased odds of stroke during CBT surgery. CONCLUSIONS In the present study history of diabetes mellitus, carotid artery disease, and vascular lesion had increased odds of stroke during CBT surgery. Findings are limited by low event rate and even larger cohorts are needed to fully define preventive preoperative strategies for preventing stroke.
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Affiliation(s)
| | | | | | - Andrea Becerril-Gaitan
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo Leon, Mexico
| | - Mirna González-González
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo Leon, Mexico; Tecnologico de Monterrey, The Institute for Obesity Research, Monterrey, Nuevo Leon, Mexico.
| | - Mario Alejandro Fabiani
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo Leon, Mexico.
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Solis-Pazmino P, Pilatuna E, Tite B, García M, Godoy R, Rocha C, Ponce OJ, Dy B, García C. Safe management of carotid body tumor resection without preoperative embolization: an Ecuadorian high-altitude cities experience. J Surg Case Rep 2022; 2022:rjac598. [PMID: 36570551 PMCID: PMC9769949 DOI: 10.1093/jscr/rjac598] [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: 11/06/2022] [Accepted: 11/26/2022] [Indexed: 12/24/2022] Open
Abstract
Carotid body tumors (CBTs) are a neoplasm that affects the carotid glomus. This study aims to improve the management of CBTs in Ecuador. This single-center, retrospective observational study was conducted at the Instituto de la Tiroides y Enfermedades de Cabeza y Cuello (ITECC). We included adults with CBTs, between January 2019 and August 2022. A total of 15 patients with CBTs were included. All patients were females living at high altitudes (>2500 m). In the Shamblin classification, 12 tumors were type II, and 3 were type III. Complete tumor resection was performed in all patients without pre-operative embolization. All patients had benign CBTs with a mean follow-up of 17, 73 months. In a time when the medical cost is high mainly in low-income countries such as Ecuador, further investigation should be undertaken in the form of randomized prospective trials to answer who would benefit from the pre-TAE procedure.
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Affiliation(s)
| | - Eduardo Pilatuna
- Instituto de la Tiroides y Enfermedades de Cabeza y Cuello (ITECC), Quito- Ecuador,CaTaLiNa (Cancer de Tiroides en America Latina)
| | - Belen Tite
- Instituto de la Tiroides y Enfermedades de Cabeza y Cuello (ITECC), Quito- Ecuador,CaTaLiNa (Cancer de Tiroides en America Latina)
| | - Mikaela García
- Instituto de la Tiroides y Enfermedades de Cabeza y Cuello (ITECC), Quito- Ecuador,CaTaLiNa (Cancer de Tiroides en America Latina)
| | - Richard Godoy
- Instituto de la Tiroides y Enfermedades de Cabeza y Cuello (ITECC), Quito- Ecuador,CaTaLiNa (Cancer de Tiroides en America Latina)
| | - Carla Rocha
- Instituto de la Tiroides y Enfermedades de Cabeza y Cuello (ITECC), Quito- Ecuador,IpathLab: Instituto de Patología y Medicina de Laboratorio, Quito-Ecuador
| | - Oscar J Ponce
- Instituto de la Tiroides y Enfermedades de Cabeza y Cuello (ITECC), Quito- Ecuador
| | - Benzon Dy
- Endocrine Surgery Department, Mayo Clinic, Rochester, Minnesota, USA
| | - Cristhian García
- Instituto de la Tiroides y Enfermedades de Cabeza y Cuello (ITECC), Quito- Ecuador
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9
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Reitz K, Ramos A, Speranza G, Chaer R, Singh M, Snyderman C, Hager E. Non-Functional Carotid Body Tumors in Patients Without Somatic Mutations May Be Considered for Non-Operative Management. Ann Vasc Surg 2022; 85:57-67. [PMID: 35472500 PMCID: PMC9627968 DOI: 10.1016/j.avsg.2022.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Carotid Body Tumors (CBT) are rare neuroendocrine paragangliomas which are typically asymptomatic and benign, with a low rate of biochemical functionality. Historically, early surgical excision was recommended to prevent development of CBT-related complications. Yet, CBT resection can result in significant cranial nerve and vascular injuries. Recent work has shown successful primary observation without resection of non-carotid body, cranial paragangliomas with slow growth and low rate of neuropathies. We hypothesize that primary observation of CBT is safe and may be considered for majority of CBT. METHODS Retrospective cohort study of patients at a multi-hospital healthcare system with radiologic identification and/or diagnostic or procedural billing codes for CBT (2000-2019). Tumor size (greatest diameter), associated symptoms, and interventions were recorded at the initial evaluation and throughout follow-up. Multivariable logistic regression investigated the risk of initial surgical resection. RESULTS A total of 108 patients (mean age, 59 ± 19 years; 67% female), with 123 CBT (mean diameter 23 ± 12 mm; 52% right) were initially evaluated by otolaryngologists (51%), vascular surgeons (25%), neurosurgeons (8%), or other (16%) medical providers. Fity-five CBT were initially resected, 63 observed, and 5 irradiated. Initial resection was associated with younger age (adjusted odd ratios aOR, 0.95 [95% confidence intervals CI, 0.92-0.97]), male sex (aOR, 4.82 [95% CI, 1.47-15.75]), and evaluation by a vascular surgeon (aOR, 6.17 [95% CI, 2.04-18.63]). Overall median follow-up was 4.7 (IQR, 2.6-9.1) years. Initially observed CBT were on an average stable in size (mean 1 ± 5 mm/year), none became biochemically active, and 2 patients became symptomatic. At the final follow-up, 63 (51%) underwent surgical resection, 54 (44%) observation, and 6 (5%) radiation therapy. Of the 63 surgically resected CBT, 5 (8%) patients had malignant CBT of which 3 (60%) had known somatic mutations (polymerase epsilon [n = 1], succinate dehydrogenase-D gene [n = 2]). Thirty percent of CBT resections had in-hospital postoperative complications, notably including 1 stroke which occurred in an initially observed patient and 16 cranial nerve complications which all occurred in immediately resected patients. Three resected CBT locally recurred, only 1 of which had malignant pathology. CONCLUSIONS Patients with newly diagnosed CBT require biochemical functionality and somatic mutation testing. In the absence of these findings, initial observation of CBTs with annual imaging and symptom monitoring may be considered an alternative to immediate resection which demonstrates a high risk of clinically meaningful postoperative complications.
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Affiliation(s)
- Katherine Reitz
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA.
| | - Anna Ramos
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | | | - Rabih Chaer
- Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Michael Singh
- Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Eric Hager
- Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA
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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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Gonzalez-Urquijo M, Castro-Varela A, Barrios-Ruiz A, Hinojosa-Gonzalez DE, Salas AKG, Morales EA, González-González M, Fabiani MA. Current trends in carotid body tumors: Comprehensive review. Head Neck 2022; 44:2316-2332. [PMID: 35838064 DOI: 10.1002/hed.27147] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/16/2022] [Accepted: 06/28/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Carotid body tumor (CBT) is a rare neoplasm that has been increasingly studied during the last decades; nevertheless, it continues to be a topic of controversy. This review aims to provide an update on the general features of CBT and particularly review different treatment strategies and primary outcomes. METHODS Data for this literature review were identified by PubMed, Scopus, and Medline. 93 articles from the initial search were included, as well as 28 relevant studies utilizing the snowballing method; totaling 121 articles about CBT. RESULTS Main features such as anatomy, embryology, genetics, clinical presentation, and diagnosis of CBT are presented, followed by evidence of different treatment strategies such as radiotherapy, preoperative embolization, vascular resection, and vascular reconstruction. Main complications are also discussed. CONCLUSION This review summarizes the most critical aspects regarding CBT. Future studies should compare different treatments to attain the best surgical results with lower morbidity rates.
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Affiliation(s)
| | - Alejandra Castro-Varela
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico
| | - Alanna Barrios-Ruiz
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico
| | | | - Ana Karen Garza Salas
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico
| | - Erick Ambriz Morales
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico
| | - Mirna González-González
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico.,Tecnologico de Monterrey, The Institute for Obesity Research, Monterrey, Nuevo León, Mexico
| | - Mario Alejandro Fabiani
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico
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12
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Yazman S, Karaagac E, Iner H, Yesilkaya NK, Eygi B, Yakut N, Yurekli I, Gurbuz A. Impact of Preoperative Embolization on Carotid Body Tumor Surgery. Ann Vasc Surg 2022; 84:155-162. [PMID: 35247534 DOI: 10.1016/j.avsg.2022.01.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/02/2022] [Accepted: 01/25/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVES In this study, investigation of the effect of preoperative carotid body tumor embolization (CBTE) on the amount of bleeding, vascular and neurological complications in carotid body tumors was aimed. METHODS 50 patients treated for 51 carotid body tumors in 2 clinics, between 2005 and 2020 were evaluated. Polyvinyl alcohol (PVA) embolization of the carotid body tumor was performed in 23 patients before the surgical excision. The results were compared with the remaining 28 patients, whom CBTE was not performed, in terms of neurological complications, requirement of additional vascular interventions, bleeding amount, and length of hospital stay. RESULTS Mean bleeding amount was significantly lower in CBTE group (406ml-217ml p<0.05). Median erythrocyte suspension (ES) transfusion was significantly lower in the CBTE group (0.3 units vs. 1.1 units, p<0.05). Neurological deficits developed in a total of 13 patients, 6 of whom were in the CBTE group and 7 in the non-CBTE group, in the early postoperative period (p=0.90). No significant difference was observed between the groups in terms of additional vascular interventions and length of hospital stay (p=0.79 and p=0.61). CONCLUSIONS Carotid body tumors are rarely encountered tumors. However, their surgical excision is challenging for surgeons regarding intraoperative and postoperative bleeding. This study demonstrates that preoperative CBTE significantly reduces the amount of bleeding, especially in Shamblin II/III tumors.
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Affiliation(s)
- Serkan Yazman
- Department of Cardiovascular Surgery, Mugla Sitki Kocman University, Faculty of Medicine, Mugla, Turkey
| | - Erturk Karaagac
- Department of Cardiovascular Surgery, Mus State Hospital, Mus, Turkey.
| | - Hasan Iner
- Department of Cardiovascular Surgery, Katip Celebi University, Faculty of Medicine, Izmir, Turkey
| | - Nihan Karakas Yesilkaya
- Department of Cardiovascular Surgery, Katip Celebi University, Faculty of Medicine, Izmir, Turkey
| | - Bortecin Eygi
- Department of Cardiovascular Surgery, Katip Celebi University, Faculty of Medicine, Izmir, Turkey
| | - Necmettin Yakut
- Department of Cardiovascular Surgery, AKUT Heart Vascular Hospital, Izmir, Turkey
| | - Ismail Yurekli
- Department of Cardiovascular Surgery, Katip Celebi University, Faculty of Medicine, Izmir, Turkey
| | - Ali Gurbuz
- Department of Cardiovascular Surgery, Katip Celebi University, Faculty of Medicine, Izmir, Turkey
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Spiriev TY, Milev M, Laleva L, Stoyanov S, Plachkov I, Staneva M, Nakov V. A rare case of carotid body tumor associated with near complete cerebral sinus thrombosis and idiopathic intracranial hypertension. Management strategy and review of the literature. Surg Neurol Int 2021; 12:262. [PMID: 34221593 PMCID: PMC8247744 DOI: 10.25259/sni_170_2021] [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: 02/16/2021] [Accepted: 04/29/2021] [Indexed: 11/04/2022] Open
Abstract
Background Carotid body tumors (CBTs) are rare hypervascular lesions with critical location which makes them very challenging to treat. In rare occasions, compression of the jugular vein from the tumor mass could predispose to progressive thrombosis of intracranial venous sinuses. The latter consequently leads to intracranial hypertension (pseudotumor cerebri) with the accompanying danger to the vision. Herewith, we present our management strategy for this rare presentation of CBTs. Case Description A 38-year-old woman, with no medical history, was admitted in the emergency unit with acute onset of headache, dizziness, and vomiting. On the diagnostic imaging studies (CT venography and MRI) a near total occlusion of all cerebral venous sinuses and a large CBT (Shambin Type II) were diagnosed. Initially, the patient was treated with anticoagulants for the thrombosis and with lumbo-peritoneal (LP) shunt for the management of pseudotumor cerebri. At a second stage, after resolution of the cerebral sinus thrombosis, the CBT was completely resected under electrophysiological monitoring, without preoperative embolization. At 1-year follow-up, the patient is neurologically intact with functioning LP shunt, patent cerebral venous sinuses, without tumor recurrence. Conclusion We present a rare case of CBT with intracranial complications, which was managed successfully by staged treatment. Careful study of the preoperative radiological and laboratory data, thorough preoperative planning of the tridimensional lesion anatomy, as well as meticulous microsurgical technique under intraoperative electrophysiological monitoring was essential for the successful outcome of the case.
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Affiliation(s)
- Toma Yuriev Spiriev
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, Bulgaria
| | - Milko Milev
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, Bulgaria
| | - Lili Laleva
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, Bulgaria
| | - Stoicho Stoyanov
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, Bulgaria
| | - Ivan Plachkov
- Department of Imaging Diagnostics Acibadem City Clinic University Hospital Tokuda, Sofia, Bulgaria
| | - Milena Staneva
- Department of Angiology, Acibadem City Clinic University Hospital Tokuda, Sofia, Bulgaria
| | - Vladimir Nakov
- Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, Bulgaria
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