Perioperative blood pressure and heart rate alterations after carotid body tumor excision: a retrospective study of 108 cases

Incidence and risk factors of cerebral hyper-perfusion syndrome like symptoms after resection of carotid body tumours

INTRODUCTION

Cerebral hyper-perfusion syndrome (CHS) is a rare but severe complication after surgery of carotid artery related disease (with a varied incidence range of 0-25.7 %), while its association with carotid body tumour (CBT) surgery is unknown. This study aimed to investigate the incidence and risk factors of CHS-like symptoms after resection of CBTs.

METHODS

This retrospective study included 152 CBT patients (165 operated tumours) who received surgery at Peking Union Medical College Hospital from March 2013 to December 2021 and had fully-available clinical records. Surgeries were performed by the several operation teams (around 4-5 teams during the study period) from the department of vascular surgery, of which the team leaders were all senior vascular surgeons who had full experience on CBT surgery. CHS-like symptom was determined based on clinical manifestation and its risk factors were identified by univariate and multivariate regression analyses.

RESULTS

The mean age of this cohort was 44.2 ± 10.9 years and female patients represented 67.1 % (102/152). There were 13 (13/152, 10.5 %) cases receiving bilateral CBT resections, generating a total of 165 operated tumours. The median maximum diameter of the tumours was 3.5 cm (IQR: 2.5-4.8 cm), with 37 (22.4 %), 40 (24.2 %) and 88 (53.3 %) lesions being classified as Shamblin I, II and III, respectively. All CBTs were completely resected under general anaesthesia, with 51 patients undergoing balloon occlusion tests (51/152, 33.6 %) preoperatively and no preoperative embolization was performed. During surgery, 34 cases (34/165, 20.6 %) underwent intervention for internal carotid artery (ICA) and 43 cases (43/165, 26.1 %) underwent external carotid artery ligation. Among the 165 operations, 43 cases developed CHS-like symptoms after surgery (26.1 %, 43/165), of which 26 cases received dehydrant therapy due to severe symptoms (60.5 %, 26/43) and most cases developed symptoms within 48 h after surgery (90.7 %,39/43). Univariate analysis revealed that occurrence of CHS-like symptoms is significantly related with elevated post-operation immediate heart rate (HR) (P = 0.006), post-operation day 1 morning HR (P = 0.004), ICA intervention (P = 0.002) and postoperative new-onset hypertension (P = 0.02). Furthermore, ICA intervention (P = 0.008) and new-onset hypertension (P = 0.017) remained the independent risk factors for development of CHS-like symptoms in multivariate regression analysis.

CONCLUSION

CBT excision is related to a significant incidence of postoperative CHS-like symptoms, of which intraoperative ICA intervention and post-operative new-onset hypertension are the independent risk factors, thus more attention and closer monitoring should be given on such patients so as to prevent life-threatening CHS-related cerebral complications.

Fifteen Years of Experience with Surgical Management of Bilateral Non-familial Carotid Body Tumors

BACKGROUND

Bilateral carotid body tumors (CBTs) clinical manifestation is infrequent. We conducted this work to describe our experience in the surgical treatment of bilateral CBT and to analyze our results.

METHODS

A retrospective, observational study. We analyzed the totality of bilateral CBT resections that had been performed in our institution from January 2008 to September 2023. Data was obtained from medical records and anonymized, ethics approval was obtained from our institution committee. As the number of observations was less than those required by the central limit theorem our sample was considered nonparametric. Statistical analysis was performed on Stata 17.

RESULTS

We evaluated 16 patients with a total of 32 CBT; surgical resection was performed in 28 cases (87.50%). Median age of the patients was 60 years (interquartile range [IQR] 46-64). Regarding the Shamblin classification, 9 CBTs (32.14%) were classified as Shamblin I, 11 (39.29%) as Shamblin II, and 8 (28.57%) as Shamblin III. The median Distance to the Base of the Skull (DTBOS) was 3.5 cm (IQR 2.7-5.1), and the median tumor volume was 11.25 cc (IQR 3.4-18.7). The median bleeding volume was 300 ml (IQR 200-500), and the median surgical time was 190 min (IQR 145-240). All surgeries were performed using the Retrocarotid Dissection technique. We documented 9 (32.14%) cases of nerve injuries, all of which were transitory. In the median regression a statistically significant association was found between DTBOS, Shamblin classification and tumor volume with intraoperative bleeding and length of stay.

CONCLUSIONS

Surgical treatment remains safe and should be considered the gold standard for accurate histologic diagnosis. DTBOS and tumor volume, in addition to Shamblin classification, must be considered in preoperative planning to predict bleeding and hospital stay.

The value of color doppler ultrasonography combined with computed tomography angiography and magnetic resonance angiography in the preoperative quantification and classification of carotid body tumors: a retrospective analysis

BACKGROUND

Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) provide accurate vascular imaging information, but their use may be contraindicated. Color Doppler ultrasonography (CDU) provides simple, safe, noninvasive, and reproducible imaging. We therefore investigated the role of preoperative CDU combined with CTA and MRA in the quantification, typing, and diagnosis of carotid body tumors (CBTs).

METHODS

We retrospectively analyzed patients with CBTs categorized into group A (type I [n = 1] and type II [n = 10]) or group B (type III [n = 56]) per the intraoperative Shamblin classification. CDU, CTA, and MRA characteristics of CBTs were observed, surgical results were correlated, and the diagnostic threshold of the CBT classification was calculated.

RESULTS

CBTs were usually located at the common carotid artery bifurcation, encircling the carotid artery. An increased angle was found between the internal and external carotid arteries. On CDU, CBTs primarily presented as homogeneous hypoechoic masses with clear boundaries, rich flow signals, and a high-speed, low-resistance artery-like flow spectrum. CTA showed uniform or heterogeneous marked enhancement. MRA showed mixed T1 and slightly longer T2 signals and uniform or uneven obvious enhancement. With increases in the lesion size, amount of blood transfused, and operation time, the intraoperative classification level and possibility of skull-base invasion increased. When the maximum diameter of the lesion, the volume of the tumor, the distance between the upper margin of the tumor to the mastoid and the mandibular angle were 3.10 cm, 10.15 cm3, - 3.26 cm, and 0.57 cm, respectively, the largest Youden index was the best diagnostic boundary value for Shamblin type III tumors.

CONCLUSIONS

CDU combined with CTA and MRA can accurately evaluate the size and classification of CBTs.