Is Preoperative Embolization Necessary for Carotid Paraganglioma Resection: Experience of a Tertiary Center

Gözen, Emine Deniz; Tevetoğlu, Fırat; Kara, Sinem; Kızılkılıç, Osman; Yener, Murat

doi:10.1177/0145561320957236

Cited by 13 publications

(9 citation statements)

References 37 publications

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“…116,117 This view is not universally endorsed and other studies suggest that preoperative embolization of these tumors does not attenuate the risks of surgery. 48,118,119 These authors state that preoperative embolization does not adequately embolize the tumor feeding vessels in HNPGLs and exposes the patient to an unnecessary procedure. They also point to increased risk of stroke in patients who have undergone preoperative embolization.…”

Section: Preoperative Embolizationmentioning

confidence: 99%

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Contemporary management of paragangliomas of the head and neck

Cleere

Martin-Grace

Gendre

et al. 2021

Laryngoscope Investig Oto

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Head and neck paragangliomas (HNPGLs) are rare neuroendocrine tumors typically arising from nonsecretory head and neck parasympathetic ganglia. Historically thought of as aggressive tumors that warranted equally aggressive surgical intervention, evidence has emerged demonstrating that the vast majority of HNPGLs are slow growing and indolent. It is also now recognized that a large proportion of HNPGLs are hereditary with succinate dehydrogenase gene mutations typically implicated.These recent advances have led to significant changes in the way in which clinicians investigate and treat HNPGLs with most now opting for more conservative treatment strategies. However, a proportion of patients present with more aggressive disease and still require nonconservative treatment strategies. Recent studies have sought to determine in which groups of patients the morbidity associated with treatment is justified. We summarize the recent advances in the understanding and management of these tumors and we provide our recommendations regarding the management of HNPGLs.

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Section: Preoperative Embolizationmentioning

confidence: 99%

“…Issues also surround inter-clinician efficacy when performing tumor embolization with wildly varied results between different institutions. 48,118,119 As such it is difficult to endorse this practice at present.…”

Section: Preoperative Embolizationmentioning

confidence: 99%

Contemporary management of paragangliomas of the head and neck

Cleere

Martin-Grace

Gendre

et al. 2021

Laryngoscope Investig Oto

View full text Add to dashboard Cite

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“…However, different authors recommend that surgery should be performed on the same day as the embolization [27] . This variability in the time between embolization and surgery, the different embolizing materials used, and patient selection bias is the probable reason that some studies report the non-efficacy of presurgical embolization in the treatment of CP [28] , [29] , [30] .…”

Section: Discussionmentioning

confidence: 99%

Carotid paragangliomas. Alternatives for presurgical endovascular management

Gaviria

Ovaez

Rodea

et al. 2022

Radiology Case Reports

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“…Thus far, several reports have described the effectiveness of preoperative embolization (71)(72)(73). However, several reports have reported no efficacy of preoperative embolization (74)(75)(76)(77).…”

Section: Preoperative Embolization -Effective or Non-effective?mentioning

confidence: 99%

Challenges of Surgical Resection of Carotid Body Tumors - Multiple Feeding Arteries and Preoperative Embolization

et al. 2022

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Background: Carotid body tumor is a hypervascular tumor with multiple feeding arteries and unique orientation at the carotid bifurcation. Although resection is a radical therapy for this tumor, complete resection is challenging. Materials and Methods: Articles reporting carotid body tumor treatment and surgical resection were reviewed including case-control series and review articles. Results: Selected reports were reviewed and discussed focusing on choice of treatment, surgical difficulties and preoperative embolization of feeding arteries. Conclusion: Multiple feeding arteries and adhesion of the tumor to the carotid arterial wall are causes of difficulties in carotid body tumor resection. The effectiveness of preoperative embolization remains controversial due to the varied situations in performing surgical resection among the institutions. However, perfect embolization and resection immediately after embolization reduce blood loss and operative time of surgery for carotid body tumor.Carotid body tumor (CBT) is a rare disease that originates from the paraganglion cells (paraganglioma) of the carotid body at the carotid bifurcation. The World Health Organization classification designated this tumor as malignant because it has a malignant potency and there is no requirement to distinguish benign from malignant features in the pathological findings of specimens (1).It is well-known that malignant tumors cannot always be identified by their morphological features in histopathological examinations; clinical findings such as metastatic activity can distinguish malignant tumors from their benign counterparts. Only clinical findings, such as lung, liver, or bone metastasis, indicate that a tumor is malignant. The slow-growing feature of CBT represents an almost benign character and embryonic origin plus germline mutation of this tumor. Its potential for metastatic activity highlights the need for surgical resection. Surgical resection of CBT by head and neck surgeons must be considered once a patient is referred to a hospital. However, in contrast to the slow-growing feature of this tumor, characteristic features, such as a rich vascular network of its capsule supplied by many feeding arteries, complicate resection (2).In recent years, it has been revealed by molecular biological studies that various types of gene alterations exist in the succinate dehydrogenase (SDH) gene family such as point mutations (3-5). Most patients with CBT were shown to have variants with germline mutations, such as SDHB and SDHD. Conversely, the idea of "hereditary paragangliomapheochromocytoma syndrome" has been frequently used to explain patients with familial paraganglioma, and it extends to patients with CBT who have a family history of the disease and gene alterations (6-8). Therefore, analyses of gene alterations are needed for patients with CBT. In addition, systemic diagnosis is needed to identify other types of paraganglioma, such as pheochromocytoma, since patients with SDH variants tend to have multiple paragangliomas (9).The Sha...

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Is Preoperative Embolization Necessary for Carotid Paraganglioma Resection: Experience of a Tertiary Center

Cited by 13 publications

References 37 publications

Contemporary management of paragangliomas of the head and neck

Contemporary management of paragangliomas of the head and neck

Carotid paragangliomas. Alternatives for presurgical endovascular management

Challenges of Surgical Resection of Carotid Body Tumors - Multiple Feeding Arteries and Preoperative Embolization

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