1
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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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2
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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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3
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Gonzalez-Urquijo M, Hinojosa-Gonzalez D, Viteri-Pérez VH, Llausas-Villarreal A, Becerril-Gaitan A, González-González M, Fabiani MA. An analysis from the CAPACITY database of outcomes of preoperative embolization before carotid body tumor surgery compared with resection alone. J Vasc Surg 2023; 77:1447-1452. [PMID: 36646333 DOI: 10.1016/j.jvs.2023.01.012] [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: 07/11/2022] [Revised: 01/06/2023] [Accepted: 01/07/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVE There is no definitive consensus on the impact of preoperative embolization on carotid body tumor (CBT) treatment. The objective of this study was to compare surgical outcomes of patients who underwent preoperative embolization before CBT resection vs patients who underwent resection alone. METHODS The CAPACITY registry included 1432 patients with CBT from 11 medical centers in four different countries. The group of patients undergoing CBT resection with preoperative embolization was matched in a 1:6 ratio from a pool of patients from the CAPACITY database, using a generated propensity score with patients who did not underwent preoperative embolization. RESULTS A total of 553 patients were included for analysis. Mean patient age was 56.23 ± 12.22 years. Patients were mostly female (n = 469; 84.8%). Bilateral CBT was registered in 60 patients (10.8%). Seventy-nine patients (14.3%) underwent preoperative embolization. Embolized patients had larger CBT sizes than non-embolized patients (33.8 mm vs 18.4 mm; P = .0001). Operative blood loss was lower in the embolized group compared with the non-embolized group (200 mL vs 250 mL; P = .031). Hematomas were more frequent in the non-embolized group (0% vs 2.7%; P = .044). Operative time, rates of stroke, cranial nerve injuries, and death were not statistically significant between groups. CONCLUSIONS Embolization before CBT resection was associated with significantly lower blood loss and lower neck hematomas than patients who underwent resection alone. Operative time, stroke, cranial nerve injuries, and death were similar between groups.
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Affiliation(s)
| | - David Hinojosa-Gonzalez
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, México
| | | | | | - Andrea Becerril-Gaitan
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, México
| | - Mirna González-González
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, México; Tecnologico de Monterrey, The Institute for Obesity Research, Monterrey, Nuevo León, México
| | - Mario Alejandro Fabiani
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, México.
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4
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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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5
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Degollado-García J, Medina-Pizarro M, Cano-Velazquez G, Balcázar-Padrón JC, Gutierrez-Avila O, Nathal E. Microsurgical treatment of carotid body tumors using periadventitial dissection: Analysis of outcomes and prognostic factors in a neurological referral center. Surg Neurol Int 2022; 13:487. [DOI: 10.25259/sni_572_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/24/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Surgical resection for carotid body tumors (CBTs) is the gold standard of treatment and continues to be a challenging procedure, commonly associated with high vascular injury rates and neurological complications.
Methods:
It is a retrospective case series study between January 2002 and November 2020, with a mean follow-up of 29 months in a single nationwide referral center. Thirty-one patients diagnosed with a carotid body tumor and treated with microsurgical periadventitial resection were included in the study. Patients’ demographics, comorbidities, clinical, radiological factors, and tumor grade, evaluated by the Shamblin scale, were obtained. Statistical analysis was performed on all collected data.
Results:
In this study, we included 31 patients (32 tumors), 80% of the patients were female, and 20% were male, with a mean age of 53 years. One patient presented with bilateral lesions, while 17 tumors were located on the left side. The most frequent symptom was a painless, slow-growing neck mass in 74% of patients. Using the Shamblin classification, 13% of tumors were Grade I, 53% Grade II, and 34% Grade III. In the postoperative period, 3% of patients presented with permanent cranial nerve deficit, while none had vascular injuries or postoperative stroke. A tumor >5 cm increased the risk for nerve lesion by 11 times (OR 12.6, CI 95% 7.4-11.4, P < 0.001).
Conclusion:
Preoperative embolization followed by periadventitial resection by means of a microsurgical technique is a safe and effective approach to remove CBT, with 3% cranial nerve injury rate and no need for vascular sacrifice or reconstruction.
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Affiliation(s)
- Javier Degollado-García
- Department of Vascular Neurosurgery, Instuto Nacional de Neurología y Neurocirugía “Manuel Velasco Suárez” - Mexico City, Mexico
| | - Mauricio Medina-Pizarro
- Department of Neurological Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, United States,
| | - Gerardo Cano-Velazquez
- Department of Vascular Neurosurgery, Instuto Nacional de Neurología y Neurocirugía “Manuel Velasco Suárez” - Mexico City, Mexico
| | - Juan C. Balcázar-Padrón
- Department of Vascular Neurosurgery, Instuto Nacional de Neurología y Neurocirugía “Manuel Velasco Suárez” - Mexico City, Mexico
| | - Oscar Gutierrez-Avila
- Department of Neurological Surgery, Hospital Civil de Guadalajara. Guadalajara City, Mexico
| | - Edgar Nathal
- Department of Vascular Neurosurgery, Instuto Nacional de Neurología y Neurocirugía “Manuel Velasco Suárez” - Mexico City, Mexico
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6
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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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7
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Wu Z, Qiu P, Pu H, Ye K, Liu G, Li W, Liu X, Yin M, Jiang M, Qin J, Lu X, Zhao Z. Efficacy and safety of preoperative embolization in carotid body tumor treatment: A propensity score matching retrospective cohort study. Head Neck 2022; 44:1414-1421. [PMID: 35319144 DOI: 10.1002/hed.27038] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/10/2022] [Accepted: 03/09/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To assess the efficacy and safety of preoperative embolization (PE) in patients with carotid body tumor (CBTs). METHODS In a single-center retrospective cohort study, 127 patients underwent surgical resection of CBTs from January 2003 to December 2019. One-to-one propensity score matching was conducted between patients with or without PE. RESULTS Thirty-two (25.2%) patients received PE. After propensity score matching, no statistically significant differences were found in the baseline characteristics of 28 patients in each group. Compared with NPE group, operative time and estimated blood loss (EBL) were significantly reduced in the PE group. The incidence of stroke, perioperative complications, intraoperative blood transfusion, vascular reconstruction, hospital stay, tumor recurrence, and all-cause mortality were not different between the PE and NPE group. CONCLUSIONS Preoperative embolization was efficient and safe with a reduction of intraoperative blood loss and operative time during CBT resection.
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Affiliation(s)
- Zhaoyu Wu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Vascular Center of Shanghai Jiaotong University, Shanghai, China
| | - Peng Qiu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Vascular Center of Shanghai Jiaotong University, Shanghai, China
| | - Hongji Pu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Vascular Center of Shanghai Jiaotong University, Shanghai, China
| | - Kaichuang Ye
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Vascular Center of Shanghai Jiaotong University, Shanghai, China
| | - Guang Liu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Vascular Center of Shanghai Jiaotong University, Shanghai, China
| | - Weimin Li
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Vascular Center of Shanghai Jiaotong University, Shanghai, China
| | - Xiaobing Liu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Vascular Center of Shanghai Jiaotong University, Shanghai, China
| | - Minyi Yin
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Vascular Center of Shanghai Jiaotong University, Shanghai, China
| | - Mier Jiang
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Vascular Center of Shanghai Jiaotong University, Shanghai, China
| | - Jinbao Qin
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Vascular Center of Shanghai Jiaotong University, Shanghai, China
| | - Xinwu Lu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Vascular Center of Shanghai Jiaotong University, Shanghai, China
| | - Zhen Zhao
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Vascular Center of Shanghai Jiaotong University, Shanghai, China
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8
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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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9
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Moscona-Nissan A, Saldívar-Rodea CA, Enríquez-García R, Rincón-Ángel LI, Calzada AN, Seidman-Sorsby A, Cruz-Zermeño M. Bilateral carotid body tumor case: A novel preoperative management. Radiol Case Rep 2022; 17:1021-1029. [PMID: 35140832 PMCID: PMC8813562 DOI: 10.1016/j.radcr.2021.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022] Open
Abstract
Paragangliomas are rare neuroendocrine neoplasms. The most common form of these tumors in head and neck are non-functional carotid body tumors. These neoplasms may present an extensive growth and compromise vital neurovascular structures in the neck, such as carotid vessels. Carotid body tumors usually present clinically as painless neck masses and occur most frequently in adults averaging 45 to 50 years, being the majority of these tumors unilateral and only 5% of all cases bilateral. The main treatment for carotid body paragangliomas is surgical resection, which can be extremely challenging due to tumor hypervascularity and significant blood loss. We present a bilateral carotid body tumor case in a 61-year-old woman who presented due to a pulsatile and painless mass in the right carotid region of the neck of 1-year of evolution. The tumor was found encasing the external carotid artery and classified as Shamblin II. A novel approach for preoperative management was performed, placing a covered graft-stent in the right common and proximal (C1) internal carotid arteries in order to splint and provide structural protection for carotid vessels during surgical resection and temporarily reduce blood flow of the carotid body tumor.
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Affiliation(s)
- Alberto Moscona-Nissan
- School of Medicine, Universidad Panamericana, Mexico City, Mexico
- Corresponding author. Alberto Moscona-Nissan.
| | - Carlos A Saldívar-Rodea
- Interventional Radiology Department, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
| | - Rocío Enríquez-García
- Interventional Radiology Department, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
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10
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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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11
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Illuminati G, Pasqua R, Nardi P, Fratini C, Minni A, Calio' FG. Results of resection of carotid body tumors with and without lymphnodes' dissection. Surg Oncol 2021; 37:101555. [PMID: 33819851 DOI: 10.1016/j.suronc.2021.101555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/05/2021] [Accepted: 03/26/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Carotid body tumor (CBT) is a slow-growing tumor arising from the carotid body, a chemoceptor organ lying behind the carotid artery bifurcation. Although rarely, metastases can occur distally through the hematogenous route and through the lymphatic route.to the cervical lymphnodes. The purpose of this study was to assess whether lymphnodes' resection should systematically be associated with the primary resection of a CBT. METHODS A retrospective analysis of 82 patients, 52 women of a mean age of 42 years undergoing resection of 88 CBT from 1994 to 2019. CBT were divided into 2 groups. Tumors in group A (n = 23, 26%) were treated by resection of the mass followed by a selective latero-cervical lymphadenectomy; tumors in group B (n = 65, 74%) underwent isolated resection of the mass. The study's primary endpoints were postoperative stroke/mortality rate, disease-specific survival and rate of local and distant recurrence of the disease. RESULTS Postoperative stroke-mortality rate was nil. One patient in group A (4.3%) presented a minor weakness of the contralateral arm, completely regressive within 12 h. One patient in group B (1.5%) died of liver and lung metastases 51 months after operation, no patient died of recurrent disease in group A (p = .62). No nodal recurrence was observed in group A, whereas one patient in group B (1.5%) presented nodal recurrence 39 months after primary tumor resection (p = .58) CONCLUSION: Selective lymphadenectomy associated with CBT resection does not increase the overall long-term survival and cannot be considered mandatory. It may help to better define the stage of the disease and to plan eventual adjuvant treatments.
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Affiliation(s)
- Giulio Illuminati
- The Departments of Surgical Sciences and University of Rome "La Sapienza", Rome, Italy.
| | - Rocco Pasqua
- The Departments of Surgical Sciences and University of Rome "La Sapienza", Rome, Italy
| | - Priscilla Nardi
- The Departments of Surgical Sciences and University of Rome "La Sapienza", Rome, Italy
| | - Chiara Fratini
- The Departments of Surgical Sciences and University of Rome "La Sapienza", Rome, Italy
| | - Antonio Minni
- Sense Organs, University of Rome "La Sapienza", Rome, Italy
| | - Francesco G Calio'
- The Department of Vascular Surgery, Sant'Anna Hospital, Catanzaro, Italy
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12
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Wernick BD, Furlough CL, Patel U, Samant S, Hoel AW, Rodriguez HE, Tomita TT, Eskandari MK. Contemporary management of carotid body tumors in a Midwestern academic center. Surgery 2020; 169:700-704. [PMID: 32868107 DOI: 10.1016/j.surg.2020.07.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/25/2020] [Accepted: 07/25/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Carotid body tumors are rare, neurogenic tumors arising from the periadventitial chemoreceptive tissue of the carotid body. The purpose of this study is to ascertain the presentation and preoperative risk factors associated with surgical resection. METHODS A single-center retrospective review of 25 carotid body tumor resections from 2002 to 2019. Demographics, periprocedural details, and postoperative outcomes were analyzed using Stata (Stata Corporation, College Station, TX). RESULTS Among 25 patients, 64% were women, 84% were asymptomatic, and the mean age was 49 years (range 21-79). Forty-four percent of tumors were Shamblin III. Nine patients underwent preoperative embolization but did not correlate with decreased blood loss (299 cm3 vs 205 cm3, P = .35). The 30-day death, stroke, and cranial nerve injury rates were 0%, 8%, and 32%, respectively. Cranial nerve injuries included 20% vagus, 4% hypoglossal, 4% facial, and 4% glossopharyngeal, with permanent deficits in 4% (n = 1). Mean length of stay was 3.0 days (range 1-9 days). At a mean follow-up of 12 months (range 1-63 months), there has been no recurrence. CONCLUSION Although carotid body tumors are uncommon in the Midwest, complete surgical resection is curative of these typically hormonally inactive tumors. Preoperative embolization did not affect blood loss, and the incidence of death, stroke, and permanent cranial nerve injury rates remained very low.
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Affiliation(s)
- Brian Daniel Wernick
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Courtney L Furlough
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Urjeet Patel
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sandeep Samant
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Andrew W Hoel
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Heron E Rodriguez
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Tadaki T Tomita
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mark K Eskandari
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
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13
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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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14
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Sevil FC, Tort M, Kaygin MA. Carotid Body Tumor Resection: Long-Term Outcome of 67 Cases without Preoperative Embolization. Ann Vasc Surg 2020; 67:200-207. [PMID: 32234392 DOI: 10.1016/j.avsg.2020.03.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/10/2020] [Accepted: 03/13/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Carotid body tumors (CBTs) are rare tumors in the neck. Surgical resection is the gold standard of treatment. Surgical resection may be complicated by bleeding. Preoperative embolization has recently been introduced for the treatment to reduce the quantity of blood loss; however, the outcomes of this procedure are still under debate. In this article, we have presented the outcomes of patients who underwent surgical resection for CBT without undergoing preoperative embolization in our institution. METHODS This retrospective study reviewed 67 tumor resection cases who underwent surgical resection for CBTs without undergoing preoperative embolization. Tumor classification was performed as per the Shamblin classification. The demographic, clinical characteristics, and the operative information about the patients were retrieved from the patient records. The obtained data were analyzed with descriptive statistics. RESULTS The study included 12 male and 55 female patients. The mean age was 51.95 ± 16.59 years. Of the surgically resected tumors; 11 (16.4%) were Shamblin type I, 30 (44.8%) were Shamblin type II, and 26 (38.8%) were Shamblin type III. The mean duration of operation was 109.10 ± 32.36 min. The volume of intraoperative blood loss in the Shamblin type I, type II, and type III groups were 98.64 ± 23.46 cc, 215.33 ± 75.74 cc, and 351.73 ± 62.51 cc, respectively, and they were significantly different among the groups (P < 0.001). The volume of postoperative blood loss in the Shamblin type I, type II, and type III groups were 34.09 ± 10.44 cc, 53.00 ± 20.02 cc, and 62.50 ± 25.11 cc, respectively, and they were significantly different among the groups (P = 0.003). Cranial nerve injury developed in 10 (15.0%) patients. Postoperative stroke developed in 2 (3%) patients. No mortality or persistent nerve injury was observed in association with the injury in the patients during the 1-year follow-up period. CONCLUSIONS CBTs can be surgically resected safely and effectively without a need for preoperative embolization.
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Affiliation(s)
- Fehim Can Sevil
- Department of Cardiovascular Surgery, Afyonkarahisar Health Sciences University Hospital, Afyonkarahisar, Turkey.
| | - Mehmet Tort
- Department of Cardiovascular Surgery, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Mehmet Ali Kaygin
- Department of Cardiovascular Surgery, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
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15
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Han T, Wang S, Wei X, Xie Y, Sun Y, Sun H, Zhu J, Wu Y, Zhou J, Zhao Z, Jing Z. Outcome of Surgical Treatment for Carotid Body Tumors in Different Shambling Type Without Preoperative Embolization: A Single-Center Retrospective Study. Ann Vasc Surg 2020; 63:325-331. [DOI: 10.1016/j.avsg.2019.08.088] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/17/2019] [Accepted: 08/03/2019] [Indexed: 12/16/2022]
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16
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Bryant JP, Wang S, Niazi T. Carotid Body Tumor Microenvironment. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1296:151-162. [PMID: 34185291 DOI: 10.1007/978-3-030-59038-3_9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Carotid body tumors (CBTs) are rare paragangliomas, comprising 0.5% of all head and neck tumors, and 65% of head and neck paragangliomas. A majority of CBTs occur sporadically, while 15% are familial or hyperplastic in the setting of chronic hypoxia. They usually present as unilateral, well-circumscribed rubbery masses, arising at the level of the carotid bifurcation. A majority of CBTs are painless and therefore may evade diagnosis for months to years. Symptomatic lesions occur due to progressive cranial nerve IX, X, or XII dysfunction, manifesting as hoarseness, dysphagia, vertigo, coughing, or odynophagia. Other local symptoms include neck discomfort, pulsatile tinnitus, hearing loss, or carotid sinus syndrome. Appropriate workup includes a thorough physical exam followed by radiographic imaging, vascular studies, and biochemical workup with 24 h urinary catecholamine or metanephrine analysis. The management of these tumors, which involves standalone surgical resection or following embolization for larger and more vascular tumors, will also be discussed.
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Affiliation(s)
| | - Shelly Wang
- Miller School of Medicine, University of Miami, Miami, FL, USA.,Division of Pediatric Neurosurgery, Brain Institute, Nicklaus Children's Hospital, Miami, FL, USA
| | - Toba Niazi
- Miller School of Medicine, University of Miami, Miami, FL, USA. .,Division of Pediatric Neurosurgery, Brain Institute, Nicklaus Children's Hospital, Miami, FL, USA.
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17
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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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18
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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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19
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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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20
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Shah SK, Levine S, O'Leary J, Belkin M. Symptomatic carotid stenosis and ipsilateral carotid body tumor. VASA 2018; 47:424-426. [PMID: 29911935 DOI: 10.1024/0301-1526/a000725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We report an unusual combination of a symptomatic carotid stenosis and ipsilateral carotid body tumor. This patient was successfully treated with simultaneous carotid endarterectomy and tumor resection. Following, the unique challenges and technique are discussed.
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Affiliation(s)
- Samir K Shah
- 1 Division of Vascular Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Seth Levine
- 2 Division of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - James O'Leary
- 1 Division of Vascular Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Michael Belkin
- 1 Division of Vascular Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
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21
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Zeitler DM, Glick J, Har-El G. Preoperative Embolization in Carotid Body Tumor Surgery: Is it Required? Ann Otol Rhinol Laryngol 2017; 119:279-83. [DOI: 10.1177/000348941011900501] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives We compared estimated blood loss (EBL) in patients who underwent surgical excision of carotid body tumors (CBTs) after preoperative superselective angiography with embolization (PSE) with that in patients who underwent excision of CBTs without PSE. Methods We performed a retrospective chart review of a consecutive case series in a single surgeon's practice within an academic tertiary care medical center. Twenty-five patients underwent surgical resection of a CBT from 1989 to 2009. From 1989 to 1996, 10 consecutive patients had PSE of the CBT, whereas the subsequent 15 patients (1996 to 2009) had no PSE. Demographic data including age, sex, and tumor size were collected. The EBL was obtained from intraoperative records and operative notes dictated at the time of surgery. Tumor size was based on preoperative radiographic measurements by a senior radiologist and the surgeon. Results In the 10 patients with PSE, the mean age was 41 years (range, 22 to 72 years) and the mean tumor size was 4.8 cm (range, 2.9 to 8.3 cm). The mean EBL was 305 mL (range, 50 to 1,000 mL); 2 patients had an EBL of more than 400 mL. In the 15 patients without PSE, the mean age was 43.7 years (range, 20 to 75 years) and the mean tumor size was 4.4 cm (range, 2.8 to 7.9 cm). The mean EBL was 265.6 mL (range, 40 to 900 mL); 2 patients had an EBL of more than 400 mL. There were no significant differences between the 2 groups with regard to age, tumor size, or EBL. Conclusions Preoperative superselective angiography with embolization of a CBT does not lead to a significant reduction in intraoperative EBL.
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Affiliation(s)
- Daniel M. Zeitler
- Department of Otolaryngology-Head and Neck Surgery, Lenox Hill Hospital and New York University School of Medicine, New York, New York
| | - Joelle Glick
- Department of Otolaryngology-Head and Neck Surgery, Lenox Hill Hospital and New York University School of Medicine, New York, New York
| | - Gady Har-El
- Department of Otolaryngology-Head and Neck Surgery, Lenox Hill Hospital and New York University School of Medicine, New York, New York
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22
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Rangel CM, Jaramillo S, Varón CL, Prada AM. Iatrogenic central retinal artery occlusion after carotid body tumor embolization and excision. GMS OPHTHALMOLOGY CASES 2017; 7:Doc09. [PMID: 28401029 PMCID: PMC5366802 DOI: 10.3205/oc000060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: To report a case of iatrogenic central retinal artery occlusion after embolization and surgical resection of carotid body paraganglioma. Methods: Case report Results: One adult female patient presented with persistent unilateral visual loss after embolization with Embosphere® and Contour® microparticles of carotid body tumor. Fluorescein angiography revealed intraluminal microspheres in the central retinal artery ramifications. OCT revealed intraretinal spherical, hyporeflective particles with posterior shadowing. Conclusions: Central retinal artery occlusion should be assessed as a possible complication after surgical repair of head and neck paragangliomas.
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Affiliation(s)
- Carlos M Rangel
- Retina and Vitreous Department, Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle, Bucaramanga, Colombia
| | - Sergio Jaramillo
- Retina and Vitreous Department, Clínica Oftalmológica del Café, Manizales, Colombia
| | - Clara L Varón
- Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle, Bucaramanga, Colombia
| | - Angélica M Prada
- Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle, Bucaramanga, Colombia
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23
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Abstract
The most common vascular tumors encountered by the otolaryngologist are rare chromaffin cell tumors termed paragangliomas. Within the head and neck region, they commonly arise from the carotid body, vagus nerve (glomus vagale), and jugular vein (glomus jugulare). Other vascular head and neck tumors include sinonasal malignancies, because of proximity to or involvement of the pterygoid plexus as well as the rich vascularity of the sinonasal mucosa; juvenile nasopharyngeal angiofibroma, a vascular tumor of male adolescents; unusual vascular tumors such as hemangiopericytoma; and metastatic renal cell cancer, which has a proclivity for an unusually rich blood supply.
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Affiliation(s)
| | - Christine Gourin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA.
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24
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Management of carotid body tumor in pediatric patients: A case report and review of the literature. Int J Pediatr Otorhinolaryngol 2017; 93:47-52. [PMID: 28109497 DOI: 10.1016/j.ijporl.2016.12.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 12/13/2016] [Accepted: 12/13/2016] [Indexed: 11/21/2022]
Abstract
Carotid body tumors (CBTs) are rare types of extra-adrenal paragangliomas, which originate from the neuroendocrine cells of the adventitial layer of carotid bifurcation. An 8-year-old girl was admitted to our department with left-sided and pulsating neck swelling, which progressively grew over several months. The patient had no family history of CBTs. Computed tomography (CT) and CT angiography (CTA) scans revealed a contrast material enhancing, hypervascularized mass involving the left carotid bifurcation, internal carotid artery (ICA), and external carotid artery (ECA), respectively. Preoperative embolization and surgical resection were performed. Histopathological examination later confirmed a benign CBT. Current follow-up examination revealed no evidence of residual or recurrent tumor. A systemic review of the literature indicates that early diagnosis, and experienced multi-disciplinary management is required in case of unilateral, resectable forms of CBTs with no distant metastasis, in order to provide a long-time survival of patients. Surgical intervention of unilateral, solitary CBTs with preoperative embolization is a relatively safe procedure, allowing complete tumor removal with minimal morbidity and low recurrence rate.
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Davila VJ, Chang JM, Stone WM, Fowl RJ, Bower TC, Hinni ML, Money SR. Current surgical management of carotid body tumors. J Vasc Surg 2016; 64:1703-1710. [DOI: 10.1016/j.jvs.2016.05.076] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/13/2016] [Indexed: 10/20/2022]
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Lamblin E, Atallah I, Reyt E, Schmerber S, Magne JL, Righini C. Neurovascular complications following carotid body paraganglioma resection. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 133:319-324. [DOI: 10.1016/j.anorl.2016.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Management of Carotid Bifurcation Tumors: 30-Year Experience. Ann Vasc Surg 2016; 34:200-5. [DOI: 10.1016/j.avsg.2015.12.029] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 11/24/2015] [Accepted: 12/09/2015] [Indexed: 11/22/2022]
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Mourad M, Saman M, Stroman D, Brown R, Ducic Y. Evaluating the role of embolization and carotid artery sacrifice and reconstruction in the management of carotid body tumors. Laryngoscope 2016; 126:2282-7. [DOI: 10.1002/lary.26006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 02/20/2016] [Accepted: 03/09/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Moustafa Mourad
- Department of Otolaryngology-Head and Neck Surgery; New York Eye and Ear Infirmary of Mt. Sinai, New York; New York U.S.A
| | - Masoud Saman
- Otolaryngology and Facial Plastic Surgery Associates; Fort Worth Texas U.S.A
| | - David Stroman
- Otolaryngology and Facial Plastic Surgery Associates; Fort Worth Texas U.S.A
| | - Ryan Brown
- Department of Otolaryngology-Head and Neck Surgery; Kaiser-Permanente; Denver Colorado U.S.A
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates; Fort Worth Texas U.S.A
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Prabakaran S, Subburayulu AS, Ravikumar PT. Surgical Excision of Carotid Body Tumor Through Modified Approach-A Case Report. J Maxillofac Oral Surg 2016; 15:251-5. [PMID: 27298550 PMCID: PMC4871837 DOI: 10.1007/s12663-015-0832-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: 05/01/2015] [Accepted: 07/30/2015] [Indexed: 11/27/2022] Open
Abstract
Paragangliomas arising from the carotid body in the carotid bifurcation are termed as carotid body tumors. They are usually slow growing and asymptomatic. Considering the anatomical location, invasion or pressure on the adjacent vascular and neural tissues, the importance of early diagnosis and management is critical. In this article a case of carotid body tumor excised through transverse neck skin crease incision is presented along with literature review on the diagnosis, grading and different surgical approaches.
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Affiliation(s)
| | | | - P. T. Ravikumar
- />Department of Oral Medicine and Radiology, Vinayaka Missions Sankarachariyar Dental College, Salem, India
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Abu-Ghanem S, Yehuda M, Carmel NN, Abergel A, Fliss DM. Impact of preoperative embolization on the outcomes of carotid body tumor surgery: A meta-analysis and review of the literature. Head Neck 2016; 38 Suppl 1:E2386-94. [PMID: 26876818 DOI: 10.1002/hed.24381] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND There is no consensus on the impact of preoperative embolization (EMB) on the surgical outcomes of carotid body tumor (CBT) resections. METHODS A systematic review and a meta-analysis were conducted to clarify the role of preoperative EMB in patients undergoing surgical removal of CBTs. RESULTS Fifteen studies with a total number of 470 patients met the inclusion criteria. The results of the meta-analysis showed that there is no significant difference in estimated blood loss, operative time, length of hospital stay, or risks of cranial nerve injury, vascular injury, and stroke between the EMB and nonembolization (NEMB) groups. CONCLUSION This systemic review and meta-analysis demonstrate that preoperative EMB does not confer any operative or postoperative advantage in patients scheduled for CBT surgery. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2386-E2394, 2016.
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Affiliation(s)
- Sara Abu-Ghanem
- Department of Otolaryngology - Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Moshe Yehuda
- Department of Otolaryngology - Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Narin Nard Carmel
- Department of Otolaryngology - Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Avraham Abergel
- Department of Otolaryngology - Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dan M Fliss
- Department of Otolaryngology - Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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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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Galyfos G, Stamatatos I, Kerasidis S, Stefanidis I, Giannakakis S, Kastrisios G, Geropapas G, Papacharalampous G, Maltezos C. Multidisciplinary Management of Carotid Body Tumors in a Tertiary Urban Institution. Int J Vasc Med 2015; 2015:969372. [PMID: 26783464 PMCID: PMC4689957 DOI: 10.1155/2015/969372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 11/17/2022] Open
Abstract
Objective. Aim of this study is to present the experience of our institution in carotid body tumors (CBTs) treatment. Methods. All cases treated in a Vascular Surgery Department within 2.5 years (03/2013-09/2015) were retrospectively evaluated. Demographics, diagnostic, and treatment strategy were recorded. All patients with known CBT underwent ultrasound and magnetic resonance imaging preoperatively. All cases were classified according to the Shamblin type and evaluated by a radiologist, otolaryngologist, and anesthesiologist before and after surgery. Major outcomes included mortality, stroke, cranial nerve injury, and recurrence. Results. Overall, nine patients (mean age: 59.5 ± 16.3 years) with a total of ten CBTs were treated. There was no gender prevalence and most of the cases (55%) were asymptomatic. There were no functional or familial cases. There was only one bilateral case treated in a staged manner. No preoperative embolization of CBTs was performed. Mortality and stroke rates were null. No severe complication was observed in the early and late setting. No malignancy was recorded. Mean follow-up was 15.6 ± 7.8 months. Conclusions. Multidisciplinary management of patients with CBTs is imperative for optimal results, especially in type III tumors, bilateral or functional cases. After careful treatment planning and intraoperative manipulations, complications could be avoided even without preoperative embolization.
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Affiliation(s)
- George Galyfos
- Department of Vascular Surgery, KAT General Hospital, 14561 Athens, Greece
| | - Ioannis Stamatatos
- Department of Vascular Surgery, KAT General Hospital, 14561 Athens, Greece
| | - Stavros Kerasidis
- Department of Vascular Surgery, KAT General Hospital, 14561 Athens, Greece
| | - Ioannis Stefanidis
- Department of Vascular Surgery, KAT General Hospital, 14561 Athens, Greece
| | | | | | - Georgios Geropapas
- Department of Vascular Surgery, KAT General Hospital, 14561 Athens, Greece
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Jackson RS, Myhill JA, Padhya TA, McCaffrey JC, McCaffrey TV, Mhaskar RS. The Effects of Preoperative Embolization on Carotid Body Paraganglioma Surgery. Otolaryngol Head Neck Surg 2015; 153:943-50. [DOI: 10.1177/0194599815605323] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 08/20/2015] [Indexed: 12/12/2022]
Abstract
Objective There is no definitive consensus on the impact of preoperative embolization on carotid body paraganglioma management. The purpose of this study was to assess the effects of preoperative embolization on carotid body paraganglioma excision. Data Sources A systematic search was conducted without limits, and it included studies published on or before July 2013 from PubMed, CINAHL, Web of Knowledge, and the Cochrane Library. Relevant synonyms for the search terms “paraganglioma,”“carotid body tumor,” and “embolization” were applied. Review Methods Studies evaluating patients undergoing surgical intervention with embolization for carotid body tumors were included. Two reviewers independently assessed the titles and abstracts for inclusion and extracted the data. The guidelines set forth by the Cochrane Collaboration were followed in the process of data extraction. Data were pooled with a fixed effects model, and standardized mean difference (SMD) and 95% confidence intervals (95% CIs) are reported. Results A total of 22 studies (15 nonrandomized studies with a comparator, 7 single-arm studies) were included, enrolling 578 patients with 607 tumors. Patients undergoing preoperative embolization had significantly less estimated blood loss compared with those of surgical excision only (12 studies; 295 tumors; SMD: –0.52; 95% CI: –0.77, –0.28). Patients undergoing preoperative embolization had less operative time compared with that of surgical excision only (6 studies; 174 tumors; SMD: –0.46; 95% CI: –0.77, –0.14). Conclusion Surgical excision with preoperative embolization appears to decrease estimated blood loss and operative time when compared with that without preoperative embolization for carotid body paragangliomas.
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Affiliation(s)
- Ryan S. Jackson
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Jeffrey A. Myhill
- Department of Otolaryngology, NEA Baptist Clinic, Jonesboro, Arkansas, USA
| | - Tapan A. Padhya
- Department of Otolaryngology–Head and Neck Surgery, University of South Florida, Tampa, Florida, USA
- Department of Head and Neck Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Judith C. McCaffrey
- Department of Head and Neck Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Thomas V. McCaffrey
- Department of Otolaryngology–Head and Neck Surgery, University of South Florida, Tampa, Florida, USA
- Department of Head and Neck Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Rahul S. Mhaskar
- Division of Evidence-Based Medicine, Department of Internal Medicine, University of South Florida, Tampa, Florida, USA
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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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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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Gupta M, Mir FA, Pandey A, Singh S, Bathla A, Prasad J. Our experience of carotid body tumours. Indian J Thorac Cardiovasc Surg 2014. [DOI: 10.1007/s12055-014-0320-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Ong H, Fan X, Ji T. Radical resection of a Shamblin type III carotid body tumour without cerebro-neurological deficit: Improved technique with preoperative embolization and carotid stenting. Int J Oral Maxillofac Surg 2014; 43:1427-30. [DOI: 10.1016/j.ijom.2014.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 06/16/2014] [Accepted: 07/21/2014] [Indexed: 10/24/2022]
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Demir T, Uyar I, Demir HB, Sahin M, Gundogdu G. Five-year follow-up of a patient with bilateral carotid body tumors after unilateral surgical resection. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:426-30. [PMID: 25278171 PMCID: PMC4188141 DOI: 10.12659/ajcr.891150] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patient: Female, 34 Final Diagnosis: Carotid body tumor Symptoms: Dysphagia • hoarseness • non-tender neck swelling Medication: — Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
- Tolga Demir
- Department of Cardiovascular Surgery, Beylikdüzü Kolan Hospital, Istanbul, Turkey
| | - Ibrahim Uyar
- Department of Cardiovascular Surgery, Acute Cardiovascular Hospital, Izmir, Turkey
| | - Hale Bolgi Demir
- Department of Cardiovascular Surgery, Medicana International Hospital, Istanbul, Turkey
| | - Mazlum Sahin
- Department of Cardiovascular Surgery, Beylikdüzü Kolan Hospital, Istanbul, Turkey
| | - Gokcen Gundogdu
- Department of Pathology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
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Spinelli F, Massara M, La Spada M, Stilo F, Barillà D, De Caridi G. A simple technique to achieve bloodless excision of carotid body tumors. J Vasc Surg 2014; 59:1462-4. [DOI: 10.1016/j.jvs.2013.10.075] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 09/17/2013] [Accepted: 10/11/2013] [Indexed: 10/25/2022]
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Alaraj A, Pytynia K, Carlson AP, Krishna PH, Charbel FT, Amin-Hanjani S, Aletich V. Combined preoperative onyx embolization and protective internal carotid artery covered stent placement for treatment of glomus vagale tumor: review of literature and illustrative case. Neurol Res 2013; 34:523-9. [DOI: 10.1179/1743132812y.0000000036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
| | - Kristen Pytynia
- Department of OtolaryngologyUniversity of Illinois at Chicago, IL, USA
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Erdogan BA, Bora F, Altin G, Paksoy M. Our experience with carotid body paragangliomas. Prague Med Rep 2013; 113:262-70. [PMID: 23249657 DOI: 10.14712/23362936.2015.9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Carotid body paragangliomas (CBP) are rare neoplasms arising from the small chemoreceptor organ in the adventitia of the common carotid bifurcation. The aim of this study is to present the diagnostic process, performed treatment and obtained results in patients with carotid body paragangliomas of the Department of Otolaryngology of Istanbul Education and Research Hospital between March 1997 and November 2008. Retrospective analysis was carried out, based on the medical documentation of 5 patients with carotid body paragangliomas (3 women and 2 men), age range 44 to 68 years with a mean of 59.6 years. Four of the patients were diagnosed and treated with Shamblin type II tumor, one of the patients with type I. Physical examination, radiological evaluation, method of the treatment and post-treatment complications were studied. The most common and single symptom was nonspecific neck mass. Preoperative diagnostic evaluation consisted of a color duplex ultrasonography, computerized tomography with contrast enhancement, magnetic resonance imaging and digital subtraction angiography. In all patients with Shamblin type I and II, blunt dissection of the tumor was conducted smoothly in the subadventitial plane. Postoperative vagus nerve and hypoglossal nerve deficit were reported in one case. Carotid body paraganglioma excision has higher risk of cranial nerve paresis and carotid artery injury, so it requires careful handling and good surgical skills to ensure complete removal.
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Affiliation(s)
- B A Erdogan
- Department of Otolaryngology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey.
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Paridaans MPM, van der Bogt KEA, Jansen JC, Nyns ECA, Wolterbeek R, van Baalen JM, Hamming JF. Results from craniocaudal carotid body tumor resection: should it be the standard surgical approach? Eur J Vasc Endovasc Surg 2013; 46:624-9. [PMID: 24091094 DOI: 10.1016/j.ejvs.2013.08.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 08/26/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To evaluate results after carotid body tumor (CBT) surgery using a novel dissection technique. METHODS A retrospective analysis of all operated CBT in the last 6 years was carried out and results were compared with the current literature and our previous series, which reported another 111 cases operated on until 2005. RESULTS Forty-five CBTs were removed in 41 (56% hereditary cases) patients (seven Shamblin I, 22 II, and 16 III). There were no cases of permanent cranial nerve injury or stroke. These pre- and postoperative results compare favorably with our previous series and are superior to, generally smaller, studies reported in the contemporary literature. CONCLUSIONS This large series of surgically-treated CBTs supports craniocaudal dissection as the surgical technique of choice as it limits blood loss and facilitates safe CBT resection.
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Affiliation(s)
- M P M Paridaans
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Chan JYK, Li RJ, Gourin CG. Short-term outcomes and cost of care of treatment of head and neck paragangliomas. Laryngoscope 2013; 123:1645-51. [DOI: 10.1002/lary.23856] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 08/21/2012] [Accepted: 10/08/2012] [Indexed: 11/09/2022]
Affiliation(s)
- Jason Y. K. Chan
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University; Baltimore; Maryland; U.S.A
| | - Ryan J. Li
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University; Baltimore; Maryland; U.S.A
| | - Christine G. Gourin
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University; Baltimore; Maryland; U.S.A
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Jagtap SR, Bakhshi RG, Khatavkar SS, Phadtare SJ, Mohite SN. Carotid body tumour excision: Anaesthetic challenges and review of literature. Indian J Anaesth 2013; 57:76-8. [PMID: 23716773 PMCID: PMC3658344 DOI: 10.4103/0019-5049.108576] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Sheetal R Jagtap
- Department of Anaesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Nerul, Navi Mumbai, Maharashtra, India
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Sen I, Stephen E, Malepathi K, Agarwal S, Shyamkumar NK, Mammen S. Neurological complications in carotid body tumors: a 6-year single-center experience. J Vasc Surg 2013; 57:64S-8S. [PMID: 23336858 DOI: 10.1016/j.jvs.2012.06.114] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 06/11/2012] [Accepted: 06/12/2012] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Carotid body tumors are considered rare. However, there has been an increase in the number of these tumors managed at our center in recent years. Delayed presentation with large tumors is common. We studied the clinical profile, interventions, and outcomes of these tumors and assessed the factors influencing operative neurological morbidity and recurrence. METHODS This retrospective study was conducted at the Christian Medical College in Vellore, a tertiary care center in south India. We analyzed the inpatient and outpatient records of patients diagnosed to have carotid body tumors undergoing excision from January 1, 2005 to December 31, 2011. Patients diagnosed to have vagal paragangliomas were excluded. RESULTS Thirty-four of 48 tumors were excised from 32 patients (11 female, 21 male). Average age at presentation was 38.2 years, and three patients had familial bilateral tumors. All patients presented with a painless neck mass. There were 27 Shamblin group III, six Shamblin group II, and one Shamblin group I tumor. Eleven Shamblin group II/III tumors were associated with transient cranial nerve palsy or paresis (32.3%). Two Shamblin group III tumors were associated with perioperative stroke (5.8%). Preoperative embolization was done in 17 tumors, 12 of which were associated with neurological complications (two stroke, nine nerve palsy, one hemianopia). One patient underwent thrombolysis for a middle cerebral artery thrombus and recovered completely on follow-up, and another with a capsuloganglionic infarct managed conservatively had minimal persistent disability. Three patients had persistent nerve palsy (8.8%). Although complications were more common in patients with higher Shamblin group tumors, the difference was not statistically significant. CONCLUSIONS The overall rate of neurological complications is higher with tumors of higher Shamblin groups. Preoperative embolization was not effective in reducing neurological complications. The rates of postoperative stroke and permanent cranial nerve palsy after resection of large tumors are acceptable.
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Affiliation(s)
- Indrani Sen
- Department of Vascular Surgery, Christian Medical College, Vellore, India.
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Clinical characteristics and strategy for treatment of functional carotid body tumours. Int J Oral Maxillofac Surg 2013; 42:436-9. [DOI: 10.1016/j.ijom.2012.09.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 06/19/2012] [Accepted: 09/14/2012] [Indexed: 11/21/2022]
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47
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Impact of preoperative embolization on outcomes of carotid body tumor resections. J Vasc Surg 2012; 56:979-89. [DOI: 10.1016/j.jvs.2012.03.037] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 03/01/2012] [Accepted: 03/10/2012] [Indexed: 11/23/2022]
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48
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Feijoo Cano C, Carranza Martinez J, Rivera Rodríguez M, Vázquez Berges I, Herrando Medrano M, Marco Luque M. Tumores del cuerpo carotídeo. Experiencia en 22 años y protocolo de seguimiento y despistaje familiar. ANGIOLOGIA 2012. [DOI: 10.1016/j.angio.2012.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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49
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Carotid body tumour - an experience of 8 years at SSKM Hospital, IPGME& R, Kolkata, India. Indian J Thorac Cardiovasc Surg 2012. [DOI: 10.1007/s12055-012-0143-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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50
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Zeng G, Zhao J, Ma Y, Huang B, Yang Y, Feng H. A Comparison Between the Treatments of Functional and Nonfunctional Carotid Body Tumors. Ann Vasc Surg 2012; 26:506-10. [DOI: 10.1016/j.avsg.2011.11.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 10/25/2011] [Accepted: 11/04/2011] [Indexed: 11/28/2022]
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