Preoperative Protective Stenting of the Internal Carotid Artery in the Management of Complex Head and Neck Paragangliomas: Long-Term Results

Abstract

Objectives: To investigate the long-term results of preoperative stenting of the internal carotid artery (ICA) in complex head and neck paragangliomas (HNP) as well as to report on indications and technical details of the procedure. Method: A comprehensive retrospective review of patients affected by HNP, consecutively operated on and preoperatively treated with stenting of the ICA in a quaternary referral skull base center, was performed. Results: Nineteen patients affected by complex HNP were identified, on whom 21 preoperative stenting procedures were performed. The mean follow-up period after stent insertion was 53.8 months; the patients' age ranged from 33 to 56 years. Fourteen patients were affected by tympanojugular paragangliomas, 4 by vagal paragangliomas and 1 by bilateral carotid body tumors. Five patients presented with recurrent tumors, while 7 presented with multiple or bilateral HNP. There were no complications associated with endovascular procedures. Total tumor removal was accomplished in 52.4% of the cases with 1 recurrence. An advanced stage was the main factor conditioning total removal. Clinical control was obtained in 80% of the patients with residual disease. Total tumor removal from and around the ICA was obtained in 95.2% of the cases. Long-term stent patency was evident in 20 of 21 cases. Conclusions: Preoperative stenting of the ICA represents a safe and effective procedure in selected cases, obviating the need for balloon occlusion or bypass procedures and reducing the risk of intraoperative vascular injury.

Strategies and long‐term outcomes in the surgical management of tympanojugular paragangliomas

“…Various techniques of preoperative endovascular management of the cervical, temporal, and petrous ICA have been described. These modalities include cervical‐to‐petrous ICA saphenous vein bypass grafting, PBO, and intra‐arterial reinforcement with stenting . At the Gruppo Otologico, in 2003, we developed the technique of preoperative intra‐arterial stenting of the ICA primarily for tympanojugular paragangliomas involving it (Figures and ).…”

“…In 2003, at the Gruppo Otologico, we developed the technique of preoperative intra‐arterial stenting of the ICA primarily for tympanojugular paragangliomas involvement. Since then, we have routinely used stenting of the cervico‐petrous ICA in the management of tympanojugular paragangliomas in order to preserve the integrity of the ICA during surgery, thereby alleviating the need for preoperative closure or bypass procedures . Preoperative stent insertion also allowed us to perform an aggressive dissection on the ICA with significant reduction in the risk of arterial rupture, thereby allowing complete tumor removal in cases where it was hitherto not possible …”

Surgical anatomy of the parapharyngeal space: Multiperspective, quantification‐based study

“…11,[26][27][28][29][30][31][32][33][34][35][36][37] Benign lesions are suitable for extracapsular enucleation or close-margin dissection (also called extracapsular dissection) according to the presence of a capsule and tendency to local invasion. 11,[26][27][28][29][30][31][32][33][34][35][36][37] Benign lesions are suitable for extracapsular enucleation or close-margin dissection (also called extracapsular dissection) according to the presence of a capsule and tendency to local invasion.…”

Management of the cervico‐petrous internal carotid artery in class C tympanojugular paragangliomas

“…The indications for endovascular intervention of the ICA were based on tumor extension, MRI and angiographic findings, and clinical findings (Table ). Details on the methods of endovascular intervention of the ICA have been described elsewhere . Preoperatively, all patients also underwent superselective tumor embolization 2 to 4 days before surgery.…”

“…To avoid intraoperative morbidity and mortality from vascular compromise, various modalities of management of the cervical and intratemporal ICA have been described. These modalities include cervical‐to‐petrous ICA saphenous vein bypass grafting, permanent balloon occlusion, and intravascular reinforcement with stenting . We have developed the application of preoperative stenting of the ICA in the management of TJPs since 2003 to avoid preoperative closure or bypass procedures and to protect and preserve integrity of the ICA during surgery .…”