Management of the Internal Carotid Artery in Tumors of the Lateral Skull Base: Preoperative Permanent Balloon Occlusion without Reconstruction

Sanna, Mario; Piazza, Paolo; DiTrapani, Giuseppe; Agarwal, Manoj

doi:10.1097/00129492-200411000-00023

Cited by 44 publications

(36 citation statements)

References 21 publications

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“…As a result, we proceeded to stenting in this case. Three cases had PBO of the ICA according to a protocol previously published [Sanna et al, 2004b]; in 1 case (case No. 4), this was due to a huge VP occluding the ICA, while in the other 2 cases, the reason for PBO was a huge TJP associated with a VP (cases No.…”

Section: Resultsmentioning

confidence: 99%

“…Due to its close anatomical relationship with the vagus nerve, the ICA is often affected by tumor and tends to be anteromedially displaced by VP. In cases of large VP usually more than 5 cm in diameter, the functional integrity of the circle of Willis and wall of the ICA is carefully scrutinized by MRI and intra-arterial angiography [Sanna et al, 2004b[Sanna et al, , 2009. While displacement and partial encasement of the ICA seen on MRI associated with a normal angiographic study can be safely managed by microsurgical techniques, global encasement of the ICA as shown in axial MR sections is a finding that may predict a tedious surgical dissection of the wall of the ICA.…”

Section: Discussionmentioning

confidence: 99%

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Management of Vagal Paragangliomas Including Application of Internal Carotid Artery Stenting

et al. 2011

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Background: The primary treatment of vagal paraganglioma (VP) includes ‘wait and scan’, surgery and radiotherapy. Objectives: To present the clinical findings, surgical treatment including application of internal carotid artery (ICA) stenting to facilitate surgery, and complications, as well as to review the literature and to discuss the decision-making process in the management of VP cases based on our experience and the literature. Design: A retrospective case review of 22 cases with VP. Setting: Quaternary neurotologic and skull base referral center. Material and Methods: The retrospective chart review identified 22 patients presenting with VP. Our indication for surgery was VP in younger patients, irrespective of the existence of vocal cord paralysis. Preoperative endovascular management of the ICA included permanent balloon occlusion (PBO) and stenting. The transcervical approach and the infratemporal fossa approach type A (ITFA) were used. Results: Fifteen cases had multicentric paragangliomas, 5 cases bilateral tumors, 3 cases a genetic mutation, and 2 cases a positive family history. The most common symptoms were hoarseness, tinnitus and hearing loss. The surgical approaches commonly employed for excision were the transcervical approach (9 cases) and the ITFA (12 cases), whereas 1 case did not have surgery. Three cases had PBO and 7 had intracarotid stent insertion. Gross total removal was achieved in 19 cases, and 1 case had a recurrence. Eighteen cases had no dysphagia or were well compensated after surgery. There were no significant complications noted in our series. Conclusions: In younger patients with VP, surgery should be recommended. The proper preoperative endovascular intervention and surgical approach facilitates gross total tumor removal. In the management of bilateral or familial paragangliomas, careful and appropriate decision making is essential.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Management of Vagal Paragangliomas Including Application of Internal Carotid Artery Stenting

et al. 2011

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“…We classified the VA involvement as intradural (Vi) and extradural (Ve): Vi refers to V4 segment involvement and Ve refers to V3 and terminal V2 segment involvement ( table 1 ). All patients underwent lower cranial nerve (LCN) functional assessment with fiberoptic laryngoscopy, base of skull CT, gadolinium-enhanced MRI and four-vessel angiography, and superselective tumor embolization 2 days before surgery [Sanna et al, 2004b;Sanna et al, 2008]. Preoperative occlusion by balloon or coil insertion into the VA was performed when necessary.…”

Section: Methodsmentioning

confidence: 99%

Vertebral Artery Involvement by Tympanojugular Paragangliomas: Management and Outcomes with a Proposed Addition to the Fisch Classification

et al. 2011

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Objectives: To present the management and outcomes of cases of tympanojugular paraganglioma (TJP) with vertebral artery (VA) involvement, and to propose the addition of the new ‘V’ category to the Fisch classification. Materials and Methods: Retrospective analysis of data from a quaternary neuro-otologic and skull base referral center. We studied 230 TJP patients to identify the cases with VA involvement and present their management, surgical findings and outcome. Results: Out of 230 patients, 8 patients were found to have VA involvement by TJP. The extradural artery was involved in 1 patient and the intradural VA was involved in 6 patients. The intradural and extradural VA were simultaneously involved in 1 patient. Seven of the 8 patients underwent surgery. In 2 patients, preoperative occlusion was performed (1 with balloon, 1 with coils). In 5 of these 7 patients, the tumor was successfully separated from the VA by microdissection with or without endovascular intervention. In another patient, the tumor together with the involved VA was removed. Of 7 patients who had surgery, 1 patient did not undergo endovascular intervention and had subtotal tumor removal from the VA. There were no serious complications in removing the tumor from around the VA. Conclusion: Although uncommon, the intradural or extradural VA can be involved by TJP. To avoid vascular accidents, the VA should be thoroughly evaluated at the planning stage. We advocate that the addition of a ‘V’ category would help to identify patients who need individualized VA management as part of a complete surgical evaluation.

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“…At times, certain benign skull base tumors, such as glomus jugulare and schwannomas, may engulf carotid artery necessitating planned resection. 3 But, benign thyroid nodular diseases are not known to involve carotid arteries, in spite of reaching gigantic sizes as they tend to push them away and, moreover, carotid sheath is an effective barrier for tissue invasion. Carotid encasement in thyroid cancer is considered unresectable with a rare possibility of curative resection 4 and carotid resection or reconstruction carries a high morbidity.…”

Section: 5005/jp-journals-10002-1064mentioning

confidence: 99%

Carotid Encasement by a Benign Multinodular Goiter

Bhargav¹,

Kumar²,

T³

2011

World Journal of Endocrine Surgery

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Management of the Internal Carotid Artery in Tumors of the Lateral Skull Base: Preoperative Permanent Balloon Occlusion without Reconstruction

Cited by 44 publications

References 21 publications

Management of Vagal Paragangliomas Including Application of Internal Carotid Artery Stenting

Management of Vagal Paragangliomas Including Application of Internal Carotid Artery Stenting

Vertebral Artery Involvement by Tympanojugular Paragangliomas: Management and Outcomes with a Proposed Addition to the Fisch Classification

Carotid Encasement by a Benign Multinodular Goiter

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