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Ramanathan S, Loving BA, Fontanesi J. Treatment of a Non-syndromic Carotid Body Paraganglioma Using Fast Neutron Radiotherapy: A Case Report and Review of Literature. Cureus 2023; 15:e44673. [PMID: 37799247 PMCID: PMC10550357 DOI: 10.7759/cureus.44673] [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: 08/25/2023] [Indexed: 10/07/2023] Open
Abstract
Non-syndromic carotid body paragangliomas (CBPs) are the most common head and neck CBPs. Malignant transformation or symptomatic presentation is rare, but patients may occasionally endorse tinnitus, cranial nerve (CN) deficits, and ear pulsations. Historically, treatment of CBP was primarily through surgical intervention, which predisposed patients to CN deficits and significant blood loss due to the neurovascular structures in close proximity to these tumors. More recently, the utilization of pre-treatment embolization and radiotherapy has allowed for the reduction in treatment morbidity. Stereotactic radiosurgery (SRS) and external beam radiotherapy (EBRT) have been investigated as alternatives to traditional surgical intervention, with a documented reduction in the incidence of postoperative morbidity. While several retrospective studies and meta-analyses compare outcomes following surgical and traditional radiotherapeutic interventions, currently no literature exists regarding the potential utility of fast neutron therapy in treating this disease. In this case report, we highlight a patient with a non-syndromic CBP treated with pre-treatment embolization and fast neutron therapy, review the post-treatment course, and present a review of the extant literature on the subject.
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Affiliation(s)
- Siddharth Ramanathan
- Radiation Oncology, Oakland University William Beaumont School of Medicine, Rochester Hills, USA
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2
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Wier GP, Larochelle RD, Seinfeld J, Hink EM. Orbital Venous Malformation Excision after Transcaruncular Embolization with Onyx. Case Rep Ophthalmol 2023; 14:121-126. [PMID: 37007838 PMCID: PMC10051039 DOI: 10.1159/000526830] [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: 03/15/2022] [Accepted: 08/04/2022] [Indexed: 04/04/2023] Open
Abstract
Orbital venous malformations are low-flow lesions resulting from vascular dysgenesis during development. Patients may present with vision loss, proptosis accentuated by Valsalva, and/or painful spontaneous thrombosis. The preferred treatment for symptomatic lesions is embolization combined with excision. A 34-year-old male presented to our institution from an outside emergency department with a diagnosis of presumed idiopathic orbital inflammation. For the prior month, he had been experiencing left orbital pressure, subjective eye bulging, and both diplopia and blurry vision when in peripheral gaze or when bending over. Despite initial improvement with steroids, his symptoms recurred with tapering. Visual acuity was reduced to 20/25, but pupils and motility remained normal. Biopsy demonstrated a vascular lesion characterized by fibroadipose tissue with histologically unremarkable blood vessels, and cerebral arteriography showed no high-flow components. A diagnosis of orbital venous malformation was made. He then underwent intraoperative angiography and Onyx embolization followed by excision via a transcaruncular approach. Two prior reports have described the use of Onyx in venolymphatic malformations. This report highlights a detailed approach to defining flow characteristics pre- and intraoperatively and expands upon our understanding of the use of Onyx for such cases.
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Affiliation(s)
| | | | - Joshua Seinfeld
- Department of Neurosurgery, University of Colorado, Aurora, CO, USA
| | - Eric M. Hink
- Department of Ophthalmology, University of Colorado, Aurora, CO, USA
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Huang X, Wang L, Chen Y, Liu J, Liu Y, Yang L. The Comparative Outcomes of Particulate Versus Coil Preoperative Embolization for Carotid Body Tumors. Front Oncol 2022; 12:860788. [PMID: 35692768 PMCID: PMC9174660 DOI: 10.3389/fonc.2022.860788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/26/2022] [Indexed: 11/18/2022] Open
Abstract
Till now, the effect of different embolic materials (particulate vs coil) on pre-embolization of carotid body tumors remains poorly understood. The aim of this study was to explore the comparative results between particulate and coil embolization for carotid body tumors. Thirty-seven patients with carotid body tumors who underwent embolization before surgical resection were reviewed and analyzed in this retrospective study between 2008 and 2020. Twenty-one patients were included in the particulate group, while 16 patients were included in the coil group. All procedure-related details, complications and 5-year follow-up data were collected in the study. The preoperative embolization time was obviously longer in the particulate group than in the coil group (42.6 ± 12.3 min vs. 33.7 ± 10.1 min, P =.02), and the fluo time of the procedure (864.5 ± 240.9 s vs. 729.6 ± 251.5 s) and cumulative air kerma (634.6 ± 188.4 mGy vs. 486.7 ± 164.7 mGy) value were higher in the particulate group (P =.01). The incidences of total adverse events in both groups were not significantly different (28.6% vs. 25.0%, P >.05); however, two cases of ectopic embolization only occurred in the particulate group. Interestingly, medical expenditure was higher in the particulate group than in the coil group (P =.02). For the 3-year follow-up evaluation, recurrence and all-cause mortality were similar in both groups (P >.05). Preoperative embolization with coils could be relatively safe, have a lower radiation dosage and be cost-effective for the treatment of carotid body tumors.
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Affiliation(s)
- Xun Huang
- Department of Vascular Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Lin Wang
- Department of Critical Care Medicine, Xi’an Traditional Chinese Medicine Hospital, Xi’an, China
| | - Yangjing Chen
- Department of Otolaryngology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Jianlin Liu
- Department of Vascular Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yamin Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Lin Yang
- Department of Vascular Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Lin Yang,
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4
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De Marini P, Greget M, Boatta E, Jahn C, Enescu I, Garnon J, Dalili D, Cazzato RL, Gangi A. Safety and technical efficacy of pre-operative embolization of head and neck paragangliomas: A 10-year mono-centric experience and systematic review. Clin Imaging 2021; 80:292-299. [PMID: 34467873 DOI: 10.1016/j.clinimag.2021.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/26/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To retrospectively evaluate the safety and technical success of pre-operative embolization (POE) of head and neck paragangliomas (HNP) in a single-center cohort over a 10-year period, and to benchmark our results with those derived from a systematic analysis of the available literature. METHODS All consecutive HNP embolized between November 2010 and April 2020 were included and reviewed. In total, there were 27 HNP in 27 patients [8 (30%) males; 19 (70%) females; mean age 53 ± 16 years; range 30-86]. Embolization technique, total procedure time, dose area product (DAP), complications, rate of HNP devascularization, and technical success (i.e. ≥80% devascularization of the HNP) were recorded and analyzed. A systematic analysis on the safety and technical success of POE was then conducted according to the Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Twenty-one (21/27; 78%) HNP were treated with an endovascular approach and 6/27 (22%) with a percutaneous or combined (endovascular/percutaneous) technique. Mean total procedure time and DAP were 108 ± 48 min (range 45-235) and 92.5 ± 61.3 Gy·cm2 (range 19.9-276.0), respectively. Two (2/27; 7%) complications (one minor, one major) were observed. Mean HNP devascularization was 88 ± 15% (range 23-100) with technical success achieved in 24/27 (89%) HNP. Literature analysis revealed a pooled rate of complication and technical success of 3.8% (95% CI: 0.5-8.8%) and 79.0% (95% CI: 63.6-91.6%), respectively. CONCLUSIONS POE of HNP is safe and results in extensive devascularization in the majority of treated tumors.
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Affiliation(s)
- Pierre De Marini
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France.
| | - Michel Greget
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France.
| | - Emanuele Boatta
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France.
| | - Christine Jahn
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France.
| | - Iulian Enescu
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France.
| | - Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France.
| | - Danoob Dalili
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Road, Oxford OX3 7LD, UK; School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France.
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France.
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5
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Selim M, AlJehani SH, Aljuhani AB, Awad Albayomy A. Preoperative Super-Selective Embolization of Carotid Body Tumor and Multidisciplinary Approach. Cureus 2021; 13:e12879. [PMID: 33633908 PMCID: PMC7899247 DOI: 10.7759/cureus.12879] [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] [Accepted: 01/23/2021] [Indexed: 11/25/2022] Open
Abstract
A carotid body tumor (CBT) is a rare highly vascular tumor. Therefore, the assessment of the tumor's vessels preoperatively is significant to decrease the risk of vascular complications intraoperatively. We report a case of carotid body tumor in a 40-year-old female who presented with a headache and a pulsatile right neck mass. She underwent computed tomography (CT), which demonstrated a well-circumscribed tumor mass measuring 3 X 2.7 X 3.6 cm. Preoperatively, selective embolization was performed in which Onyx 18 (Medtronic, Dublin, Ireland) and precipitating hydrophobic injectable liquid (PHIL) 25% (Microvention Inc, California) were used, and that achieved 95% embolization of tumor blood supply. One day after embolization, complete surgical resection was done by a multidisciplinary team.
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Affiliation(s)
- Mohamed Selim
- Vascular Surgery, Al Azhar Faculty of Medicine, Cairo, EGY
- Vascular Surgery, King Fahad University Hospital, Dammam, SAU
| | | | - Alaa B Aljuhani
- Surgery, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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6
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Liu J, Li Y, Yang L, Cai H. Surgical resection of carotid body tumors with versus without preoperative embolization: Retrospective case‐control study. Head Neck 2018; 40:2590-2595. [PMID: 30387536 DOI: 10.1002/hed.25387] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/16/2018] [Accepted: 05/29/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jianlin Liu
- Department of Vascular Surgerythe First Affiliated Hospital of Xi'an Jiaotong University Xi'an Shaanxi People's Republic of China
| | - Yanzi Li
- Department of Operationthe First Affiliated Hospital of Xi'an Jiaotong University Xi'an Shaanxi People's Republic of China
| | - Lin Yang
- Department of Vascular Surgerythe First Affiliated Hospital of Xi'an Jiaotong University Xi'an Shaanxi People's Republic of China
| | - Hui Cai
- Department of Vascular Surgerythe First Affiliated Hospital of Xi'an Jiaotong University Xi'an Shaanxi People's Republic of China
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7
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Moore MG, Netterville JL, Mendenhall WM, Isaacson B, Nussenbaum B. Head and Neck Paragangliomas. Otolaryngol Head Neck Surg 2016; 154:597-605. [DOI: 10.1177/0194599815627667] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 12/29/2015] [Indexed: 11/16/2022]
Abstract
Objective Head and neck paragangliomas are a group of slow-growing hypervascular tumors associated with the paraganglion system. The approach to evaluate and treat these lesions has evolved over the last 2 decades. While radical surgery had been the traditional approach, improvements in diagnostic imaging as well as radiation therapy techniques have led to an emphasis on observation and nonsurgical therapy in many patients. This article reviews the contemporary approach to the workup and management of head and neck paragangliomas. Data Source Articles were identified from PubMed. Review Methods PubMed searches with the following keywords were performed: carotid body paraganglioma management, vagal paraganglioma management, jugulotympanic paraganglioma management, imaging of head and neck paragangliomas, head and neck paraganglioma embolization, paraganglioma radiation, head and neck paraganglioma management, observation of head and neck paragangliomas, bilateral carotid body paragangliomas, and genetics of paragangliomas. Review and original research articles available in the English language and published during or after 2009 were selected on the basis of their clinical relevance and scientific strength. Certain articles published prior to 2009 were also included if they provided background information that was relevant. Conclusions/Implications for Practice Workup and treatment of head and neck paragangliomas are changing. With more now known regarding the longitudinal behavior of these tumors, observation and nonsurgical therapy are indicated in many instances. For patients where surgery is the most appropriate option, improved diagnostic and perioperative techniques are allowing patients to tolerate resection, often with reduced morbidity.
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Affiliation(s)
- Michael G. Moore
- Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - James L. Netterville
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William M. Mendenhall
- Department of Radiation Oncology, University of Florida School of Medicine, Gainesville, Florida, USA
| | - Brandon Isaacson
- Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Brian Nussenbaum
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
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8
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Felbaum DR, Syed HR, McCullough MF, Armonda RA, Liu AH, Bell RS. Embolization of Carotid Body Tumors: Revisiting Direct Puncture Technique, Preliminary Experience and Literature Review. Cureus 2016; 8:e483. [PMID: 32175212 PMCID: PMC7053799 DOI: 10.7759/cureus.483] [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] [Indexed: 11/06/2022] Open
Abstract
Preoperative embolization via transarterial route is an acceptable adjunct to the treatment of carotid body tumors (CBT). Direct tumor puncture for embolization has been previously described as a safe and feasible option. We revisit this technique and present our initial experience treating CBT via direct puncture. We identified six patients that underwent preoperative embolization of CBT using a direct puncture technique embolized with Onyx (EV3 Micro Therapeutics Inc., Irvine, CA, USA). After defining the angioarchitecture via digital subtraction angiography, the tumor was targeted with Onyx. Using a 21-gauge needle, the tumor was punctured using a fluoroscopic road mask. There were no immediate post-procedural complications following embolization. All patients underwent definitive resection within 24 hours. During surgery, the embolization material did not affect surgical maneuvers. In addition, the estimated blood loss was noted to average 50 ml. Although early in our experience, direct percutaneous embolization of CBT appears to be a reproducible and well-tolerated endovascular treatment option. Overall, the reported body of evidence available confirms the safety and efficacy of direct intralesional embolization with Onyx.
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Affiliation(s)
- Daniel R Felbaum
- Neurosurgery, Medstar Georgetown University Hospital, Washington DC, USA
| | - Hasan R Syed
- Neurosurgery, Medstar Georgetown University Hospital, Washington DC, USA
| | - Michael F McCullough
- Neurointerventional Radiology, Medstar Washington Hospital Center, Washington DC, USA
| | - Rocco A Armonda
- Neurosurgery, Medstar Georgetown University Hospital, Washington DC, USA
| | - Ai-Hsi Liu
- Neurointerventional Radiology, Medstar Washington Hospital Center, Washington DC, USA
| | - Randy S Bell
- Department of Neurosurgery, Walter Reed Army Medical Center, Washington DC, USA
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9
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Shi X, Gao H, Dai F, Feng X, Liu W. A thermoresponsive supramolecular copolymer hydrogel for the embolization of kidney arteries. Biomater Sci 2016; 4:1673-1681. [PMID: 27709136 DOI: 10.1039/c6bm00597g] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A thermoresponsive supramolecular p(N-acryloyl glycinamide-co-acrylamide) (PNAGA-PAAm) copolymer hydrogel was developed for the embolization of renal arteries in rabbits.
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Affiliation(s)
- Xiaohuan Shi
- School of Materials Science and Engineering
- Tianjin Key Laboratory of Composite and Functional Materials
- Tianjin University
- Tianjin
- China
| | - Haijun Gao
- Tianjin First Center Hospital
- Tianjin
- China
| | - Fengying Dai
- School of Materials Science and Engineering
- Key Laboratory of Advanced Textile Composites
- Ministry of Education
- Institute of Textile Composites
- Tianjin Polytechnic University
| | | | - Wenguang Liu
- School of Materials Science and Engineering
- Tianjin Key Laboratory of Composite and Functional Materials
- Tianjin University
- Tianjin
- China
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10
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Hinojosa CA, Ortiz-Lopez LJ, Anaya-Ayala JE, Orozco-Sevilla V, Nunez-Salgado AE. Comparison of retrocarotid and caudocranial dissection techniques for the surgical treatment of carotid body tumors. J Vasc Surg 2015; 62:958-64. [DOI: 10.1016/j.jvs.2015.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 05/05/2015] [Indexed: 10/23/2022]
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11
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Cobos González E, Aragón López JA, Soria Céspedes DR, de la Rosa Abaroa MA, Martínez de la Vega Celorio A, Granados Gracia M, Bargalló Rocha E. Malignant paraganglioma (multiple, multicentric and metastatic) in a female patient with family history of paraganglioma. Cir Esp 2015; 93:e127-32. [PMID: 26166401 DOI: 10.1016/j.ciresp.2015.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 05/01/2015] [Accepted: 05/08/2015] [Indexed: 10/23/2022]
Abstract
Malignant paragangliomas are rare, but may occur especially in patients with familial forms of the disease. We present the case of a 23 year old woman diagnosed with bilateral carotid paraganglioma with distant and local metastases, associated to a family history of paraganglioma and we present a literature review.
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Affiliation(s)
| | | | | | | | | | - Martín Granados Gracia
- Servicio de Oncología Quirúrgica, Instituto Nacional de Cancerología, México D.F., México
| | - Enrique Bargalló Rocha
- Servicio de Oncología Quirúrgica, Instituto Nacional de Cancerología, México D.F., México
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12
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Bercin S, Muderris T, Sevil E, Gul F, Kılıcarslan A, Kiris M. Efficiency of preoperative embolization of carotid body tumor. Auris Nasus Larynx 2015; 42:226-30. [DOI: 10.1016/j.anl.2014.10.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 10/28/2014] [Accepted: 10/31/2014] [Indexed: 11/25/2022]
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13
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Adjunct endovascular interventions in carotid body tumors. J Vasc Surg 2015; 61:1081-91.e2. [DOI: 10.1016/j.jvs.2015.01.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 01/19/2015] [Indexed: 11/22/2022]
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14
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Hashemi N, Ling JD, Soparkar C, Sami M, Ellezam B, Klucznik R, Lee AG, Chévez-Barrios P. Transarterial Onyx Embolization of an Orbital Solitary Fibrous Tumor. Ocul Oncol Pathol 2015; 1:98-102. [PMID: 27171911 DOI: 10.1159/000370048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 11/14/2014] [Indexed: 11/19/2022] Open
Abstract
Solitary fibrous tumor (SFT) is an uncommon mesenchymal neoplasm sometimes found in the orbit. We report a case of an aggressive orbital SFT with enlarged feeding vessels that was successfully resected immediately after transarterial embolization with Onyx (ethylene vinyl alcohol copolymer). To our knowledge, this is the first report showing the histopathology of Onyx embolization material in an orbital SFT.
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Affiliation(s)
- Nafiseh Hashemi
- The University of Texas Health Sciences, University of Texas, Houston Tex., USA
| | - Jeanie D Ling
- Department of Plastic Surgery, MD Anderson Cancer Center, University of Texas, Houston Tex., USA
| | - Charles Soparkar
- Department of Plastic Surgery, MD Anderson Cancer Center, University of Texas, Houston Tex., USA; Department of Ophthalmology, MD Anderson Cancer Center, University of Texas, Houston Tex., USA; Department of Ophthalmology, MD Anderson Cancer Center, University of Texas, Houston Tex., USA; Department of Division of Head and Neck Surgery, MD Anderson Cancer Center, University of Texas, Houston Tex., USA; Department of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, New York, N.Y., USA
| | - Mirwat Sami
- Department of Ophthalmology, MD Anderson Cancer Center, University of Texas, Houston Tex., USA
| | - Benjamin Ellezam
- Department of Pathology and Genomic Medicine, MD Anderson Cancer Center, University of Texas, Houston Tex., USA
| | - Richard Klucznik
- Department of Radiology, Houston Methodist Hospital, MD Anderson Cancer Center, University of Texas, Houston Tex., USA
| | - Andrew G Lee
- The University of Texas Health Sciences, University of Texas, Houston Tex., USA; Department of Baylor College of Medicine, MD Anderson Cancer Center, University of Texas, Houston Tex., USA; Department of Ophthalmology, MD Anderson Cancer Center, University of Texas, Houston Tex., USA; Department of Ophthalmology, The University of Texas Medical Branch, Galveston, Tex., USA; Department of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, New York, N.Y., USA; Department of Ophthalmology, The University of Iowa Hospitals and Clinic, Iowa City, Iowa, USA
| | - Patricia Chévez-Barrios
- Department of Baylor College of Medicine, MD Anderson Cancer Center, University of Texas, Houston Tex., USA; Department of Ophthalmology, MD Anderson Cancer Center, University of Texas, Houston Tex., USA; Department of Pathology and Genomic Medicine, MD Anderson Cancer Center, University of Texas, Houston Tex., USA; Department of Pathology and Laboratory Medicine, MD Anderson Cancer Center, University of Texas, Houston Tex., USA; Pathology and Laboratory Medicine and Ophthalmology, Weill Cornell Medical College, New York, N.Y., USA
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15
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Faragò G, Castellani C, Ponzi S, Jankovic C, Saginario V, Berardi C, Pollo B, Ciceri EF. Preoperative embolization of carotid chemodectoma: a technical challenge that can be customized according to angioarchitecture. Illustrative cases. Neuroradiol J 2013; 26:678-82. [PMID: 24355187 DOI: 10.1177/197140091302600611] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 11/12/2013] [Indexed: 11/16/2022] Open
Abstract
Preoperative embolization of carotid paraganglioma is increasingly used to reduce the risk of surgical bleeding obtaining a more precise and extensive tumor resection. Currently the technique can be customized in consideration of the different tumor angioarchitecture, thanks to embolic materials with different vascular penetration: solid particles of polyvinyl-alcohol (PVA), histoacryl glue, and liquid polymer (Onyx(®)). Two cases of swelling dissection with volume progression over time came to our observation. Both patients (45 and 70-year-old women) were studied with neck ultrasound imaging and computed tomography (CT) and/or magnetic resonance (MR). In both cases the radiological investigations confirmed the clinical suspicion of carotid paraganglioma. Both patients were sent for angiography control and preoperative devascularization of the lesion. The treatment was performed under general anesthesia using, depending on the type of tumor vasculature, in case 1 solid particles of PVA and histoacryl glue, and in case 2 Onyx(®) (Covidien, Irvine). The patients successfully underwent excision of the lesion via cervicotomy within a week from the embolization procedure, without any complications. The histological findings confirmed the diagnosis of chemodectoma, and macrophage infiltrates were seen in the regions previously embolized. At one-year follow-up, there was no evidence of recurrent disease. The preoperative embolization of vascular lesions of the neck represents a safe technique that yields the best results when customized over the type of vascularization of the lesion, enabling the use of the most appropriate materials, depending on the case to be treated.
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Affiliation(s)
- Giuseppe Faragò
- Interventional Neuroradiology, "C.Besta" Fondazione Neurological Institute; Milan, Italy -
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16
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Brajkovic S, Riboldi G, Govoni A, Corti S, Bresolin N, Comi GP. Growing Evidence about the Relationship between Vessel Dissection and Scuba Diving. Case Rep Neurol 2013; 5:155-61. [PMID: 24163671 PMCID: PMC3806682 DOI: 10.1159/000354979] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Carotid and vertebral artery dissection are relatively frequent and risky conditions. In the last decade, different patients with extracranial (and in 1 case also intracranial) dissections associated with the practice of scuba diving were reported. The connection between the two conditions has not been fully explained so far. In the present article, we report the case of a patient presenting with Claude Bernard-Horner syndrome and homolateral XII cranial nerve palsy, manifesting a few days after diving in the cold water of a lake. The patient ended up having internal carotid artery dissection associated with the formation of a pseudoaneurysm. Here, we offer a summary of all cases reported in the literature about scuba diving and arterial dissection, and provide a critical discussion about which scuba diving-related factors can trigger the dissection of cervical vessels.
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Affiliation(s)
- Simona Brajkovic
- Dino Ferrari Centre, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Neurology Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulietta Riboldi
- Dino Ferrari Centre, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Neurology Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Govoni
- Dino Ferrari Centre, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Neurology Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefania Corti
- Dino Ferrari Centre, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Neurology Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nereo Bresolin
- Dino Ferrari Centre, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Neurology Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Giacomo Pietro Comi
- Dino Ferrari Centre, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Neurology Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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17
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Percutaneous Onyx Embolization of Cervical Paragangliomas. J Vasc Interv Radiol 2011; 22:1271-4. [PMID: 21856505 DOI: 10.1016/j.jvir.2011.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 06/08/2011] [Accepted: 06/15/2011] [Indexed: 11/23/2022] Open
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18
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Avgerinos ED, Moulakakis K, Brountzos E, Giannakopoulos TG, Lazaris AM, Koumarianou A, Geronikola-Trapali X, Ptohis N, Papapetrou A, Liapis CD. Advances in assessment and management of carotid body tumors. Vascular 2011; 19:250-6. [DOI: 10.1258/vasc.2011.oa0291] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Evolving technology has the potential to alter the overall management of carotid body tumors (CBTs). We review our 35-year experience emphasizing on novel modalities available in the evaluation and treatment of CBTs. Medical records of 27 CBT patients between 1975 and 2009 were retrospectively reviewed. The study cohort has been arbitrarily divided into two groups: the early years' group A (18 patients, 1975–1998) and the later years' group B (9 patients, 1999–2009). The most common presenting symptom was a painless lateral neck mass (89%). Octreotide scintigraphy and genetic testing were routinely used for group B. In two cases, octreotide scintigraphy was coupled with intraoperative radiolocalization of the lesion. Preoperative embolization was performed in four CBTs. Among group B patients, five were pretreated via a covered stent placement in the external carotid artery (ECA). Twenty-three patients (24 CBTs) were eventually operated upon. One cardiovascular death, one permanent vocal cord paralysis and six transient cranial nerve injuries account for a 4.4% 30-day mortality and a 30.4% morbidity with no significant differences among groups. In conclusion, appropriate use of new techniques in CBT management has improved diagnostic accuracy and early detection without clearly affecting overall outcome in our study cohort.
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Affiliation(s)
| | | | | | | | | | | | - Xenia Geronikola-Trapali
- Department of Nuclear Medicine, Attikon University Hospital, Athens Medical School, Chaidari, Athens, Greece
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