Combined endovascular and surgical treatment of head and neck paragangliomas—A team approach

Persky, Mark S.; Setton, Avi; Niimi, Yasunari; Hartman, Jonathan; Frank, Douglas K.; Berenstein, Alex

doi:10.1002/hed.10068.abs

Cited by 26 publications

(56 citation statements)

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“…For children, dedicated angiography may help delineate important vascular feeders, and embolization may prevent excessive blood loss during surgery. 32,42 After embolization of vascular feeders, reduced intraoperative blood loss may improve the surgeon's visibility and reduce the risk of inadvertent nerve injury. 21,34,43 During angiography, a BTO can be performed, which can determine whether the patient can tolerate a carotid artery sacrifice during surgery or preoperatively.…”

Section: Treatmentmentioning

confidence: 99%

Multimodal management of pediatric carotid body tumors: a systematic review and case illustrations

Kuchakulla¹,

Shah²,

Armstrong³

et al. 2019

Journal of Neurosurgery: Pediatrics

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OBJECTIVECarotid body tumors (CBTs), extraadrenal paragangliomas, are extremely rare neoplasms in children that often require multimodal surgical treatment, including preoperative anesthesia workup, embolization, and resection. With only a few cases reported in the pediatric literature, treatment paradigms and surgical morbidity are loosely defined, especially when carotid artery infiltration is noted. Here, the authors report two cases of pediatric CBT and provide the results of a systematic review of the literature.METHODSThe study was divided into two sections. First, the authors conducted a retrospective review of our series of pediatric CBT patients and screened for patients with evidence of a CBT over the last 10 years (2007–2017) at a single tertiary referral pediatric hospital. Second, they conducted a systematic review, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, of all reported cases of pediatric CBTs to determine the characteristics (tumor size, vascularity, symptomatology), treatment paradigms, and complications.RESULTSIn the systematic review (n = 21 patients [includes 19 cases found in the literature and 2 from the authors’ series]), the mean age at diagnosis was 11.8 years. The most common presenting symptoms were palpable neck mass (62%), cranial nerve palsies (33%), cough or dysphagia (14%), and neck pain (19%). Metastasis occurred only in 5% of patients, and 19% of cases were recurrent lesions. Only 10% of patients presented with elevated catecholamines and associated sympathetic involvement. Preoperative embolization was utilized in 24% of patients (external carotid artery in 4 and external carotid artery and vertebral artery in 1). Cranial nerve palsies (cranial nerve VII [n = 1], IX [n = 1], X [n = 4], XI [n = 1], and XII [n = 3]) were the most common cause of surgical morbidity (33% of cases). The patients in the authors’ illustrative cases underwent preoperative embolization and balloon test occlusion followed by resection, and both patients suffered from transient Horner’s syndrome after embolization.CONCLUSIONSSurgical management of CBTs requires an extensive preoperative workup, anesthesia, and multimodal surgical management. Due to a potentially high rate of surgical morbidity and vascularity, balloon test occlusion with embolization may be necessary in select patients prior to resection. Careful thorough preoperative counseling is vital to preparing families for the intensive management of these children.

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Section: Treatmentmentioning

confidence: 99%

Multimodal management of pediatric carotid body tumors: a systematic review and case illustrations

Kuchakulla¹,

Shah²,

Armstrong³

et al. 2019

Journal of Neurosurgery: Pediatrics

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“…La angiografía además permite detectar paragangliomas sincrónicos, evaluar la permeabilidad del polígono de Willis y realizar el test de oclusión carotidea con balón. La embolización puede realizarse con distintos materiales como gelfoam, polivinilalcohol o cianoacrilato, y busca la oclusión selectiva del vaso que irriga el tumor; siendo la arteria faríngea ascendente (rama de la arteria carótida externa) la que con mayor frecuencia irriga los paragangliomas carotideos (37). Se recomienda que la embolización debiera realizarse 48 horas previas a la cirugía, para evitar fenómenos de revascularización local (30).…”

Section: Tratamientounclassified

Paraganglioma del cuerpo carotideo: Revisión bibliográfica

Sedano

Grazia

et al. 2015

Acta otorrinolaringol cir cabeza cuello

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Introducción: Los paragangliomas son tumores neuroectodérmicos que suelenencontrarse adyacentes a estructuras ganglionares autonómicas. El paraganglioma carotídeo es un tumor parasimpático, habitualmente no secretor de hormonas y de bajo potencial maligno. Objetivo: Realizar una revisión de la literatura con conceptos actuales respecto al abordaje clínico y quirúrgico de esta patología. Diseño: Revisión narrativa de la literatura. Materiales y métodos: Se realizó una búsqueda en bases virtuales como Pubmed y Scielo utilizando los términos “paraganglioma” y “tumor del cuerpo carotídeo” con el fin de encontrar documentos actualizados sobre este tema. Resultados: De lasfuentes bibliográficas halladas, se depuraron según impacto, población objeto y tiempo de publicación hasta obtener 48 documentos incluyendo artículos de revisión, reportes de caso y libros, de los cuales se sintetizó información sobre el abordaje del paraganglioma del cuerpo carotídeo. Conclusiones: Ante la presencia de una masa cervical lateral debe considerarse la posibilidad de un paraganglioma; la tomografía computada y la resonancia magnética permiten la aproximación diagnóstica y su clasificación inicial, mientras que la angiografía permite el uso de técnicas de embolización selectiva, cuyo uso en estos tumores es controvertido. La cirugía es el único tratamiento curativo y se considera el manejo de elección en la mayoría de los casos, mientras que la radioterapia se indica en aquellos casos de resecciones incompletas o cuando la cirugía está contraindicada.

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“…Since this initial study, numerous authors have reported using embolization as a useful presurgical adjunct for CBTs and other paragangliomas. [19][20][21][22][23][24][25][26][27][28] Significant reductions in blood loss 20,22,24,25 and operative time 20,24 have been observed in multiple series. Embolic agents used most commonly after superselection of feeder vessels are smaller PVA particles (typically 100 to 250 mm), followed by surgery between 1 to 14 days postembolization.…”

Section: Preoperative Embolization Of Hypervascular Tumorsmentioning

confidence: 99%

Preoperative Embolization

Rilling

Chen²

2004

Semin intervent Radiol

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Preoperative embolization procedures are constantly evolving and allow the performance of, or improve the outcome of, subsequent surgical interventions. Currently, some of the more frequently performed procedures in this group are portal vein embolization (PVE) in anticipation of extended liver resection, preoperative embolization of hypervascular tumors, and chemoembolization of hepatocellular carcinoma (HCC) as a bridge to liver transplantation. The indications, technique, and results of these procedures will be reviewed.

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Combined endovascular and surgical treatment of head and neck paragangliomas—A team approach

Cited by 26 publications

References 0 publications

Multimodal management of pediatric carotid body tumors: a systematic review and case illustrations

Multimodal management of pediatric carotid body tumors: a systematic review and case illustrations

Paraganglioma del cuerpo carotideo: Revisión bibliográfica

Preoperative Embolization

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