Radical resection of a Shamblin type III carotid body tumour without cerebro-neurological deficit: Improved technique with preoperative embolization and carotid stenting

Superselective carotid body tumor embolization with platinum-based coils

Resection of Shamblin II and III carotid body tumors can be challenging owing to the potential for significant blood loss. Prophylactic use of liquid embolic agents poses a risk of inflammatory reactions and nontarget embolization. On the other hand, coil embolization has traditionally been limited to cases involving external carotid artery sacrifice. Herein we demonstrate that superselective targeting of tumor-feeding vessels using platinum based, fully detachable packing coils is effective at sustained devascularization of Shamblin II and III carotid body tumors without subsequent inflammation, allowing for a longer interval between embolization and tumor resection, and potentially reducing blood loss without need for ligation or reconstruction of the internal or external carotid artery.

Preoperative Protective Endovascular Covered Stent Placement Followed by Surgery for Management of the Cervical Common and Internal Carotid Arteries with Tumor Encasement

Objective The objective of this study was to report the outcomes on a preliminary cohort of patients with tumor encasement of either, or both, the cervical internal carotid artery (ICA) and common carotid artery (CCA) following preoperative covered stent placement and surgical resection. Setting This study was set at the University of Florida College of Medicine, Jacksonville, FL. Participants Subjects who received preoperative stenting of the cervical ICA/CCA before surgical resection of head and neck tumors between April 1, 2015, and July 31, 2015 were participated. Main Outcome Measures The outcomes assessed were resectability of tumors after stenting, histopathological assessment of specimen margins, complications associated with stenting. Results Five subjects received preoperative covered stent placement of the ICA/CCA before surgical resection. The mean age was 65.2 years. Median follow-up was 3.5 months. Excision of the adventitia from the stent was performed in all subjects. No intraoperative complications occurred. One vascular-related complication occurred in one subject who suffered occlusion of the stent, sustaining a ministroke. No involvement of tumor at the deep margin (inner surface of adventitia) of the resection was seen in any subjects. Conclusions Preoperative covered stent placement of the cervical ICA/CCA in the management of subjects with head and neck tumors who display encasement on preoperative imaging may represent a safe and effective treatment.