Paragangliomas of head and neck – A surgical challenge

Malec, Katarzyna; Cenda, Paweł; Brzewski, Paweł; Kuchta, Krzysztof; Dobosz, Paweł; Modrzejewski, M

doi:10.1016/j.jcms.2016.10.003

Cited by 6 publications

(3 citation statements)

References 22 publications

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“…The abundant vascular supply and complex relationship with contiguous neurovascular structures poses significant challenges in surgical resection of head and neck paragangliomas. 16,17 Comorbidities such as stroke, TIA, and injury of lower cranial nerves are possible reported complications. For patients of young age with CBT, surgical extirpation is routinely recommended as the treatment option, whereas a strategy of observation or radiotherapy may be more likely recommended for patients of more advanced age (≥60 years old).…”

Section: Discussionmentioning

confidence: 99%

Resection of Carotid Body Tumors in Patients of Advanced Age: Experience From a Single Center

Zhou

et al. 2021

Ear Nose Throat J

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Introduction: Resection of carotid body tumor (CBT) in patients of advanced ages has not been appreciated. Objectives: This study aims to assess the clinical characteristics and perioperative comorbidities for CBT resection in patients of advanced age and to validate the application of an “isolated island” technique for extirpation of CBT. Methods: Eight patients of advanced age (≥60 years) who underwent CBT resection were enrolled as the study group (SG). Another 29 patients of younger age (<45 years old) underwent CBT extirpation were assigned as the control group (CG). The perioperative issues were compared between these 2 groups. Results: The “isolated island” technique was successfully applied for resection of CBT in all 37 patients. The prevalence of Shamblin classification I, II, and III tumors in the SG was 12.5%, 62.5%, and 25%; whereas in the CG was 10.3%, 55.2%, and 34.5%, respectively. Bilateral CBT was observed in 7 patients of the CG and none in the SG. Vascular reconstruction was required for 1 (12.5%) patient in the SG, while it was required for 8 (27.6%) patients in the CG. Postoperative vocal cord palsy occurred in 37.5% of patients in SG, whereas the vocal cord palsy (34.5%) and dysphagia (6.9%) were commonly encountered in CG. In addition to postoperative length of stay ( P = .004), no significant difference for operative time, intraoperative blood loss, or mortality were observed between these 2 groups ( P > .05). Conclusion: Extirpation of CBT in patients of advanced age is rationale in appropriately selected patients. The “isolated island” technique is safe for CBT resection with seemingly low complication rates.

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Section: Discussionmentioning

confidence: 99%

Resection of Carotid Body Tumors in Patients of Advanced Age: Experience From a Single Center

Zhou

et al. 2021

Ear Nose Throat J

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“…Surgical extirpation of paragangliomas arising in the head and neck region carries potential risks of vascular rupture and nerve injury. 15 Therefore, typically a team approach composed of a vascular surgeon and a head neck surgeon is required to facilitate complete and safe resection. 16 Auxiliary diagnostic methods such as the 3-D model described in this study can help appreciate the complex relationships between the tumor and the surrounding neurovascular bundle prior to and during the operation.…”

Section: Discussionmentioning

confidence: 99%

Management of Multiple Head and Neck Paragangliomas With Assistance of a 3-D Model

Chen

et al. 2021

Ear Nose Throat J

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Introduction: Extirpation of multiple head and neck paragangliomas carries challenge due to close anatomic relationships with critical neurovascular bundles. Objectives: This study aims to assess whether the application of 3-D models can assist with surgical planning and treatment of these paragangliomas, decrease surgically related morbidity and mortality. Methods: Fourteen patients undergoing surgical resection of multiple head and neck paragangliomas were enrolled in this study. A preoperative 3-D model was created based on radiologic data, and relevant critical anatomic relationships were preoperatively assessed and intraoperatively validated. Results: All 14 patients presented with multiple head and neck paragangliomas, including bilateral carotid body tumors (CBT, n = 9), concurrent CBT with glomus jugulare tumors (GJT, n = 4), and multiple vagal paragangliomas (n = 1). Ten patients underwent genomic analysis and all harbored succinate dehydrogenase complex subunit D (SDHD) mutations. Under guidance of the 3-D model, the internal carotid artery (ICA) was circumferentially encased by tumor on 5 of the operated sides, in 4 (80%) of which the tumor was successfully dissected out from the ICA, whereas ICA reconstruction was required on one side (20%). Following removal of CBT, anterior rerouting of the facial nerve was avoided in 3 (75%) of 4 patients during the extirpation of GJT with assistance of a 3-D model. Two patients developed permanent postoperative vocal cord paralysis. There was no vessel rupture or mortality in this study cohort. Conclusion: The 3-D model is beneficial for establishment of a preoperative strategy, as well as planning and guiding the intraoperative procedure for resection of multiple head and neck paragangliomas.

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“…Carotid paragangliomas (CPs), also known as carotid body tumors, are neuroendocrine tumors originating in the parenchymal cells of the neuroectoderm and neural crests, but also in the mesodermal elements of the third branchial arch [1,17,19,28,30]. Thus, the cells that make up paragangliomas are similar to the cells in the APUD (amine precursor uptake and decarboxylation) system and can release catecholamines, cholecystokinin, serotonin, somatostatin, and vasoactive intestinal peptide [20].…”

Section: Introductionmentioning

confidence: 99%

Carotid paragangliomas: case report and imaging review

Baz¹,

Scheau

Sârbu

et al. 2021

Folia Morphol

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Background: Presentation of case reviews depicting the imaging characteristics of carotid paragangliomas, associated with a thorough analysis of the anatomical morphological features and the current therapeutic strategies. Methods: We present the cases of three patients diagnosed with carotid paragangliomas in our clinic, illustrating diagnostic imaging elements by computer tomography (CT) and magnetic resonance imaging (MRI), but also the postoperative aspect of the carotid system, with respective anatomical, clinical and surgical considerations. Results: The imaging aspect of the carotid paragangliomas is characterized by a mass of soft tissue with intense contrast enhancement and with "salt and pepper" MRI appearance on conventional spin-echo sequences. The postoperative evolution of the patients included in the article was favorable, without any perioperative complications or signs of local tumor recurrence. Conclusions: Carotid paragangliomas are rare, often asymptomatic tumors, but with potential for increased malignancy, which raises the need for good knowledge of the cervical region pathology as well as the features of neuroendocrine tumors. CT and MRI examinations are essential for diagnosis, staging and, implicitly, for establishing the therapeutic strategy.

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Paragangliomas of head and neck – A surgical challenge

Cited by 6 publications

References 22 publications

Resection of Carotid Body Tumors in Patients of Advanced Age: Experience From a Single Center

Resection of Carotid Body Tumors in Patients of Advanced Age: Experience From a Single Center

Management of Multiple Head and Neck Paragangliomas With Assistance of a 3-D Model

Carotid paragangliomas: case report and imaging review

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