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Pacheco-ojeda LA. Carotid body tumors: Surgical experience in 215 cases. J Craniomaxillofac Surg 2017; 45:1472-7. [DOI: 10.1016/j.jcms.2017.06.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/22/2017] [Accepted: 06/06/2017] [Indexed: 11/20/2022] Open
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Hua Q, Xu Z, Jiang Y. Diagnosis and surgical treatment of carotid body tumor: A retrospective analysis of 58 patients. Oncol Lett 2017; 14:3628-3632. [PMID: 28927123 DOI: 10.3892/ol.2017.6582] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 02/27/2017] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to illustrate the diagnosis and treatment of carotid body tumor (CBT) based on our experience of previous patients. A total of 58 patients (62 lesions) with CBT who received surgery between October 2003 and October 2013 were included. In total, 17 lesions were categorized into Shamblin grade I, 33 were grade II, and 12 were grade III. Surgical resection of CBT was performed for 52 lesions, resection of CBT and the external carotid artery was performed for 9 lesions, and resection of CBT and the internal carotid artery was performed for 1 lesion. No hemiplegia was observed. Hoarseness and bucking were observed in 2 patients of Shamblin grade III, and were eliminated 1 month subsequent to the administration of hormone therapy and a nerve-nurturing strategy. No relapse or mortality was observed during the follow-up. In conclusion, surgical resection of CBT is recommended following diagnosis. The evaluation of imaging features and cerebral collateral circulation is important for treatment.
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Affiliation(s)
- Qingquan Hua
- Department of Otolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Zhen Xu
- Department of Otolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Yang Jiang
- Department of Otolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
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Jansen TTG, Timmers HJLM, Marres HAM, Kunst HPM. Feasibility of a wait-and-scan period as initial management strategy for head and neck paraganglioma. Head Neck 2017; 39:2088-2094. [DOI: 10.1002/hed.24871] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/02/2017] [Accepted: 05/29/2017] [Indexed: 11/11/2022] Open
Affiliation(s)
- Thijs T. G. Jansen
- Department of Otolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Henri J. L. M. Timmers
- Department of Endocrinology, Radboud Skull Base Center; Radboud University Medical Center; Nijmegen The Netherlands
| | - Henri A. M. Marres
- Department of Otolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Henricus P. M. Kunst
- Department of Otolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
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Jin ZQ, He W, Wu DF, Lin MY, Jiang HT. Color Doppler Ultrasound in Diagnosis and Assessment of Carotid Body Tumors: Comparison with Computed Tomography Angiography. Ultrasound Med Biol 2016; 42:2106-2113. [PMID: 27316787 DOI: 10.1016/j.ultrasmedbio.2016.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 04/04/2016] [Accepted: 04/07/2016] [Indexed: 06/06/2023]
Abstract
A carotid body tumor (CBT) is a rare, non-chromaffin paraganglioma, and its diagnosis mainly depends on imaging modalities. The aim of this study was to investigate the ability of color Doppler ultrasound (CDU) in the diagnosis and assessment of CBT based on computed tomography (CT). We retrospectively reviewed the CDU and CT features of 49 consecutive CBTs and 23 schwannomas from 67 patients and compared these findings with surgical resection specimens. The mean size of CBT lesions on ultrasound scans and CT angiography (CTA) was 3.24 cm ± 0.82 cm (range, 1.6-5.2 cm) and 3.84 cm ± 1.08 cm (range, 1.8-6.8 cm), respectively, which had statistically significant difference (t = 9.815, p = 0.000). The vascularity of CBT lesions was richer than that of schwannoma lesions (p < 0.05). Intra-lesional vascularities feeding CBT mostly arose from the external carotid artery and had spectrum characteristics including low velocity and resistance. Peak systolic velocity (PSV) and resistance index (RI) of the vasa vasorum were 39.8 cm/s ± 19.8 cm/s and 0.54 ± 0.06, respectively. There was the correlation between CTA and CDU in identifying Shamblin type I CBT lesions, while CTA technique was superior for CDU, identifying Shamblin type II and III CBT lesions. Accuracy, specificity and sensitivity of CDU in diagnosing CBTs were 87.5% (63 of 72), 82.6% (19 of 23) and 89.8% (44 of 49), respectively. Both accuracy and sensitivity of CTA in diagnosing CBTs were 100%. CDU can be useful for assessment of Shamblin's type and intra-lesional blood flow of CBTs before its metastases, while CT imaging can reveal the relationship between lesions and adjacent arteries, as well as the involvement of the skull base. CDU combined with CT imaging can be used as an optimal detection modality for the assessment and management of CBT.
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Affiliation(s)
- Zhan-Qiang Jin
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wen He
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Dong-Fang Wu
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mei-Ying Lin
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China
| | - Hua-Tang Jiang
- Department of Radiology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China
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Economopoulos KP, Tzani A, Reifsnyder T. Adjunct endovascular interventions in carotid body tumors. J Vasc Surg 2015; 61:1081-1091.e2. [DOI: 10.1016/j.jvs.2015.01.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [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 SK, Singla S, Karunanithi S, Damle N, Bal C. Peptide receptor radionuclide therapy with (177)Lu DOTATATE in a case of recurrent carotid body paraganglioma with spinal metastases. Clin Nucl Med 2014; 39:440-1. [PMID: 24217545 DOI: 10.1097/RLU.0000000000000273] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Paragangliomas are rare benign neuroendocrine tumors, and 80% of all paragangliomas are either carotid body tumors or glomus jugulare tumors. We present a case of recurrent unresectable carotid body paraganglioma with nodal and T7 vertebral metastases in a 30-year-old man 6 years postsurgery detected with Ga DOTANOC PET/CT and was administered with peptide receptor radionuclide therapy using Lu DOTATATE. After 5 cycles of Lu DOTATATE (total cumulative activity of 750 mCi [27 GBq]), significant response at the primary site on Ga DOTANOC PET/CT and complete disappearance of nodal and T7 vertebral metastases were noted.
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García-talavera P, Ruano R, Rioja M, Cordero J, Razola P, Vidal-sicart S. Radioguided surgery in neuroendocrine tumors. A review of the literature. ACTA ACUST UNITED AC 2014; 33:358-65. [DOI: 10.1016/j.remnie.2014.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Gad A, Sayed A, Elwan H, Fouad FMS, Kamal Eldin H, Khairy H, Elhindawy K, Taha A, Hefnawy E. Carotid body tumors: a review of 25 years experience in diagnosis and management of 56 tumors. Ann Vasc Dis 2014; 7:292-9. [PMID: 25298832 DOI: 10.3400/avd.oa.13-00116] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 06/25/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To report our experience in the management of CBTs and review the literature. MATERIALS AND METHODS 56 CBTs were operated upon over a period of 25 years. Surgical intervention was planned according to the Shamblin classification. Thirty-nine of the tumors were in males (69.64%), and 17 of the tumors were in females (30.36%). The average age was 42 (ages ranging between 32 and 47). Twenty-two tumors were diagnosed and treated with Shamblin type I, twenty-eight with type II and eight tumors with type III. All patients were unilateral except two had bilateral carotid tumors. Thirty-five lumps were de novo (group A), while 21 lumps were treated after a prior trial of removal (group B). RESULTS The incidence of carotid reconstruction was lower among group A (1/35) compared to group B (9/21). Complications were less in group A than group B (23% vs. 30%). There were 4 cases with suspected malignancy and no recurrences during the follow-up period. CONCLUSION There is an increased incidence of major vascular reconstruction in cases not properly investigated or diagnosed and in cases with prior attempts of removal in Primary Hospitals. Proper diagnosis of suspicious lumps is mandatory. Resection of CBTs by surgeons with experience in vascular reconstruction is recommended. Vascular reconstructions have to be performed safely without serious complications. Also today, prior attempts of removal are not so common, with preoperative evaluation using the latest diagnostic tools. Cranial nerves injury (especially the Hypoglossal Nv) continues to be the most common complication.
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Affiliation(s)
- Amr Gad
- Department of Vascular Surgery, Cairo University, Cairo, Egypt
| | - Ahmed Sayed
- Department of Vascular Surgery, Cairo University, Cairo, Egypt
| | - Hussein Elwan
- Department of Vascular Surgery, Cairo University, Cairo, Egypt
| | - Fouad M S Fouad
- Department of Vascular Surgery, Cairo University, Cairo, Egypt
| | | | - Hussein Khairy
- Department of Vascular Surgery, Cairo University, Cairo, Egypt
| | | | - Ahmed Taha
- Department of Vascular Surgery, Cairo University, Cairo, Egypt
| | - Engie Hefnawy
- Department of Vascular Surgery, Cairo University, Cairo, Egypt
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García-Talavera P, Ruano R, Rioja ME, Cordero JM, Razola P, Vidal-Sicart S. [Radioguided surgery in neuroendocrine tumors. A review of the literature]. Rev Esp Med Nucl Imagen Mol 2014; 33:358-65. [PMID: 25107596 DOI: 10.1016/j.remn.2014.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 07/08/2014] [Accepted: 07/09/2014] [Indexed: 11/26/2022]
Abstract
Radioguided surgery can be a useful technique in the localization of neuroendocrine tumors. It detects more and smaller lesions compared to pre-surgical imaging and intraoperative digital palpation by the surgeon. It detects residual lesions and also indicates the shortest access route to the lesion. Nevertheless, its use has not become widespread because of technical difficulties. There is a limited number of published series, a lack of standardized protocol because of the great variability regarding type of radiopharmaceutical, dose of radiotracer, timing between injection and surgery. In this paper, we review these issues, describing the experience of different authors in diverse tumors.
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Affiliation(s)
- P García-Talavera
- Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | - R Ruano
- Servicio de Medicina Nuclear, Hospital Clínico Universitario de Salamanca, Salamanca, España
| | - M E Rioja
- Servicio de Medicina Nuclear, Hospital Universitario Ramón y Cajal, Madrid, España
| | - J M Cordero
- Servicio de Medicina Nuclear, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - P Razola
- Servicio de Medicina Nuclear, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - S Vidal-Sicart
- Servicio de Medicina Nuclear, Hospital Clínic de Barcelona, Barcelona, España
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Prouse G, Mazzaccaro D, Settembrini F, Carmo M, Biglioli F, Settembrini PG. Double osteotomy of mandibula in the treatment of carotid body tumors with skull base extension. J Vasc Surg 2013; 58:486-90. [DOI: 10.1016/j.jvs.2012.11.086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 11/08/2012] [Accepted: 11/18/2012] [Indexed: 11/16/2022]
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Sanlı A, Oz K, Ayduran E, Aydın S, Altın G, Eken M. Carotid body tumors and our surgical approaches. Indian J Otolaryngol Head Neck Surg 2012; 64:158-61. [PMID: 23730577 DOI: 10.1007/s12070-011-0461-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 12/26/2011] [Indexed: 10/14/2022] Open
Abstract
Glomus tumors known as paragangliomas are neoplasms arising from the neural crest. They are named according to the place they originate from. Tumors originating from the carotid body at the carotid bifurcation are called Carotid Body Tumors (CBT). Surgical intervention is planned according to the Shamblin classification. 17 patients were operated after being diagnosed with CBT in our clinic between February 2007 and June 2010. 12 (70.5%) of the patients were male, and 5 (29.4%) of the patients were female. The average age was 42 (ages ranging between 32 and 47). Nine of the patients were diagnosed and treated with Shamblin type I tumor, seven of the patients with type II and one patient with type III. Only one patient had bilateral carotid tumor. In all patients with Shamblin type I and II, blunt dissection of the tumor was conducted smoothly by means of thermal cautery in the subadventitial plane. The patient with Shamblin type III had tumor invasion in the carotid artery and adjacent tissues were in an adherent state. Therefore mass resection was carried out by resecting 2 cm of the distal portion of the common carotid artery and 3 cm of the proximal portion of the internal carotid artery. 6 mm of synthetic polytetrafluoroethylene graft was interpositioned between the common carotid artery and the internal carotid artery. External carotid artery was anastomosed to this graft in an end-to-end fashion. The patient developed vocal cord paralysis postoperatively on the lesion side. The patient who underwent bilateral tumor excision developed Baroreflex Failure Syndrome. In the two patients thrombus developed in the internal carotid artery in the early postoperative period. These patients underwent thrombectomy and developed hemiplegia on the lesion side. One of them died on the seventh post-operative day while in follow-up in the intensive care unit. Surgical resection is the recommended treatment for carotid body tumors. Shamblin I and II type tumors' dimensions and pathological characteristics allow dissection. However Shamblin III tumors may require carotid artery resection and reconstruction due to tissue invasion. The possibility of post-operative cranial nerve paralysis and arterial thrombosis should be taken into account.
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Avgerinos ED, Moulakakis K, Brountzos E, Giannakopoulos TG, Lazaris AM, Koumarianou A, Geronikola-Trapali X, Ptohis N, Papapetrou A, Liapis CD. Advances in assessment and management of carotid body tumors. Vascular 2011; 19:250-6. [DOI: 10.1258/vasc.2011.oa0291] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Evolving technology has the potential to alter the overall management of carotid body tumors (CBTs). We review our 35-year experience emphasizing on novel modalities available in the evaluation and treatment of CBTs. Medical records of 27 CBT patients between 1975 and 2009 were retrospectively reviewed. The study cohort has been arbitrarily divided into two groups: the early years' group A (18 patients, 1975–1998) and the later years' group B (9 patients, 1999–2009). The most common presenting symptom was a painless lateral neck mass (89%). Octreotide scintigraphy and genetic testing were routinely used for group B. In two cases, octreotide scintigraphy was coupled with intraoperative radiolocalization of the lesion. Preoperative embolization was performed in four CBTs. Among group B patients, five were pretreated via a covered stent placement in the external carotid artery (ECA). Twenty-three patients (24 CBTs) were eventually operated upon. One cardiovascular death, one permanent vocal cord paralysis and six transient cranial nerve injuries account for a 4.4% 30-day mortality and a 30.4% morbidity with no significant differences among groups. In conclusion, appropriate use of new techniques in CBT management has improved diagnostic accuracy and early detection without clearly affecting overall outcome in our study cohort.
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Affiliation(s)
| | | | | | | | | | | | - Xenia Geronikola-Trapali
- Department of Nuclear Medicine, Attikon University Hospital, Athens Medical School, Chaidari, Athens, Greece
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