Carotid Body Tumor Surgery: Management and Outcomes in the Nation

Vogel, Todd R.; Mousa, Albeir Y.; Dombrovskiy, Viktor Y.; Haser, Paul B.; Graham, Alan M.

doi:10.1177/1538574409335274

Cited by 48 publications

(39 citation statements)

References 24 publications

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“…Embolization reduces morbidity and mortality and shortens the time of surgery by reducing intraoperative bleeding. This was demonstrated by Vogel et al, 15 who evaluated 2117 patients with carotid body tumors and found significantly fewer complications and decreased blood product requirements when resection was combined with preoperative embolization. Small paragangliomas are usually easier to resect; however, no study to date has evaluated the benefits and risks of embolization according to tumor size.…”

Section: Discussionmentioning

confidence: 79%

Early side effects after embolization of a carotid body tumor using Onyx

Wiegand

Kureck

Chapot

et al. 2010

Journal of Vascular Surgery

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The case of a 20-year-old woman with a carotid body tumor of Shamblin class III is reported. Ten hours after preoperative direct intralesional embolization with 20 mL Onyx (ethylene-vinyl alcohol copolymer; Micro Therapeutics, Irvine, Calif), the patient showed symptoms of Horner syndrome and deficits of the hypoglossal and glossopharyngeal nerves. Intraoperative examination 12 hours after Onyx embolization revealed a massive swelling of the hypoglossal and glossopharyngeal nerves. The patient's tongue motility and glossopharyngeal function improved after surgery, but Horner syndrome was still present. Owing to the delayed occurrence of these adverse effects, the optimal time of surgical intervention after Onyx embolization should be discussed and perhaps expedited.

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Section: Discussionmentioning

confidence: 79%

Early side effects after embolization of a carotid body tumor using Onyx

Wiegand

Kureck

Chapot

et al. 2010

Journal of Vascular Surgery

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“…We do not usually perform preoperative embolization (only 2 patients before 1992, for > 4 cm tumor, for which embolization was only partial), although it has recently been reported not to be associated with increased risk of stroke [17]. Most authors report little benefit in postoperative course, with no evidence of a decrease in morbidity in general or in cranial nerve deficit in particular [15].…”

Section: Discussionmentioning

confidence: 96%

“…The contribution of preoperative embolization is controversial [5,9,[15][16][17]. We do not usually perform preoperative embolization (only 2 patients before 1992, for > 4 cm tumor, for which embolization was only partial), although it has recently been reported not to be associated with increased risk of stroke [17].…”

Section: Discussionmentioning

confidence: 99%

Neurovascular complications following carotid body paraganglioma resection

Lamblin

Atallah

Reyt

et al. 2016

European Annals of Otorhinolaryngology, Head and Neck Diseases

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a b s t r a c tObjective: The present consecutive case series reports our experience in the management of carotid body paraganglioma and aims to assess whether the Shamblin classification or tumor size are predictive of early and late postoperative neurovascular complications. Material and methods: A retrospective study included 54 carotid body tumor resections in 49 patients, between 1980 and 2011. Data comprised early (< 1 month) and late (18 months) postoperative neurovascular complications. Results: Early postoperative complications occurred in 31 cases, including 30 cases of cranial nerve deficit (56%). Cranial nerve deficit occurred in 83% of Shamblin III carotid body paragangliomas and was associated with significantly larger mean tumor size (4 ± 1.4 cm versus 2.9 ± 1.3 cm; P < 0.01). Shamblin III tumor and tumor size > 3.2 cm emerged as predictive factors for early postoperative peripheral neurological complications. Eight patients (17%) showed no cranial nerve deficit recovery, even after 18 months' follow-up; no predictive factors could be identified for this. Conclusion: Surgical resection remains the only curative treatment in carotid body paraganglioma, with low vascular morbidity. However, early postoperative nerve deficit remains frequent (56%), although mostly temporary, with 17% definitive sequelae at 18 months. Tumor size and Shamblin classification are predictive of early neurovascular complications.

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“…According to Makeieff et al [17], the rate of serious complications (i.e., permanent nerve palsy, vascular complications) was 2.3 % for Shamblin Class I/II tumors and 35.7 % for Shamblin Class III tumors. Nevertheless, internal carotid resection with or without vascular reconstruction when the artery is enveloped by the tumor has been reported in as much as 12.5-18 % of surgically treated patients [5,18,19]. According to Vogel et al [19] who carried out a systematic review including 1988 patients who underwent CBT surgery, those with reconstruction of the carotid artery had significantly greater rate of mortality (1.61 vs. 0.59 %) and stroke (17.7 vs. 3.5 %) compared to the rest of patients.…”

Section: Treatment Of Carotid Body Paragangliomasmentioning

confidence: 99%

“…Nevertheless, internal carotid resection with or without vascular reconstruction when the artery is enveloped by the tumor has been reported in as much as 12.5-18 % of surgically treated patients [5,18,19]. According to Vogel et al [19] who carried out a systematic review including 1988 patients who underwent CBT surgery, those with reconstruction of the carotid artery had significantly greater rate of mortality (1.61 vs. 0.59 %) and stroke (17.7 vs. 3.5 %) compared to the rest of patients. To summarize, although ''wait and scan'' is an option in most of the patients younger than 60 years with a single Class I CBT, surgery should be considered as the first choice therapy, since under these circumstances it produces minimal morbidity, almost no mortality, and a very good chance to really cure the patient.…”

Section: Treatment Of Carotid Body Paragangliomasmentioning

confidence: 99%

Modern trends in the management of head and neck paragangliomas

Suárez

Fernández-Álvarez

Neumann³

et al. 2015

Eur Arch Otorhinolaryngol

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Head and neck paragangliomas (HNPG) are rare, mostly benign neoplasms that usually exhibit an indolent growth pattern although they can be associated with compression and infiltration of adjacent cranial nerves and, depending on the site of origin, also bone and intracranial structures. Less than 5 % of the tumors are considered malignant based on the presence of metastases and not local invasion. Carotid body tumors accounts for two-thirds of HNPG, whereas vagal paragangliomas are showing the highest tendency toward malignant character.Despite the usual treatment of benign tumors is surgery, the risks of the treatment-related complications and potential deterioration of quality of patient's live, however, should not be greater than the risk brought by the tumor in its natural course. Watchful waiting and radiotherapy are widely accepted in the management of vestibular schwannomas, a tumor that is usually indolent but, like HNPG, also has an unpredictable growth pattern. Review of different national tumor registry databases revealed that in the United States there has been a significant shift in management of vestibular schwannomas over a decade, with increasing tendency toward observation and radiotherapy, whereas the proportion of operated cases declined to near a half of the total [1][2][3]. Similar studies on the trends of treatment are lacking in HNPG. Systematic analysis of the literature has shown that most of the HNPG have been treated surgically, with no data on the impact of observation in the management of these tumors [4,5]. ''Wait and see'' policyLikewise, due to prevailingly indolent nature HNPG with low growth potential the decision on optimal treatment in HNPG is delicate, even more in view of the facts that tumor growth in individual paraganglioma (PG) case cannot be predicted and mortality caused directly by the tumor is a rare event that occurs in only 1-4 % of patients [4]. According to Jansen et al. [6], the median increase in size in a series of 48 HNPG was 0.83 mm/year. A volume increase of 20 % was noted in 60 % of the tumors, with a median increase in dimension in this subgroup of 1 mm/ year. In addition, tumor doubling time has been universally estimated as low, ranging between 4.2 and 13.8 years for HNPG [7,8].

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Carotid Body Tumor Surgery: Management and Outcomes in the Nation

Cited by 48 publications

References 24 publications

Early side effects after embolization of a carotid body tumor using Onyx

Early side effects after embolization of a carotid body tumor using Onyx

Neurovascular complications following carotid body paraganglioma resection

Modern trends in the management of head and neck paragangliomas

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