Surgical Management of Bilateral Carotid Body Tumors

Background: Carotid paragangliomas are rare tumors. They are usually unique, non-secreting, resectable, and benign. However, additional rare cases of complex tumors (bilateral, secretory, nonresectable, or malignant) complicate the management and final outcomes. Methods: Records of paragangliomas from our hospital are reviewed. Criteria defining complex paragangliomas have been previously defined. These are compared with those of the simple group. Results: Fifty patients, two groups: simple (n = 39) and complex (n = 11). The patients in the complex group were significantly younger (47.7 vs 63.8 years). Postoperative nerve complications (45.4% vs 6.3%) and mortality during follow-up (27.3% vs 0%) were significantly more common in the complex group. Vascular complications (0% vs 3.1%) and early mortality (0%) were similarly in both groups. Conclusions: Patients with complex carotid paragangliomas are heterogeneous. The former are younger, exhibit a high degree of diagnostic and therapeutic complexity, and have poorer morbidity and mortality. Surgical experience and interdisciplinary collaboration are essential.

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“…Between 5% and 10% of CPGs are bilateral 43 ; in our series, the figure was 10%. In these situations, special considerations must also be made.…”

Section: Bilateral Cpgscontrasting

confidence: 50%

Simple and complex carotid paragangliomas. Three decades of experience and literature review

et al. 2020

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“…For patients with bilateral CBT or multiple vagal paragangliomas, the choice of resection was routinely selected on the side with lower Shamblin classification or less potential occurrence of complications. 18 If no postoperative issues such as vocal cord palsy or dysphagia occurred during resection of the initial side, continued resection of the contralateral lesion was considered, 19 as well as observation or radiotherapy may be indicated depending on patient preference. We used the same strategy for treatment of multicentric bilateral paragangliomas; however, only 3 patients agreed to resection of the contralateral lesion.…”

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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“…4 Even though CBTs are usually benign asymptomatic neoplasms, their proximity to cranial nerves as to the vasculature in the neck can result in signs and symptoms that are reported to cause a decrease in the HRQoL. 4,5,12,13,14 As aforementioned, surgical resection is a wellestablished treatment in these patients; however, assessment of HRQoL has become a subject of great importance when deciding which treatment could bring more benefit to the patients; given that the near absence of the pathology (i.e. complete tumor resection) does not always mean an improvement in the patient's HRQoL.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Assessment of health-related quality of life in patients prior to carotid body tumor resection

et al. 2019

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Background Carotid body tumors represent approximately 0.5% of the total head and neck tumors, and the most common presentation form is an asymptomatic cervical mass. Despite of being most of them asymptomatic the quality of life could be impacted; however, the literature remains silent about this matter. The Short Form 36 (SF-36) is a health-related quality of life (HRQoL) instrument that includes eight domains to assess physical and emotional function in different diseases. The aim of this study was to compare HRQoL in preoperative patients with carotid body tumor and a control paired group. The secondary objective was to compare HRQoL between carotid body tumor patients according to the volume tumor and Shamblin classification. Methods A cross-sectional study that included 23 patients diagnosed with carotid body tumor prior to resection and 23 control patients paired by age and gender was conducted from January 2017 to December 2018. The SF-36 questionnaire was applied in 46 patients. Three-dimensional volume reconstruction and estimation (3DVR) was obtained from a preoperative computed tomography angiography (CTA). Descriptive statistical analysis was performed for demographics and categorical variables were reported by frequencies and percentages. Continuous variables were summarized using median with interquartile ranges (IQR) with 95% confidence interval (CI) and were compared. Differences between medians were analyzed with the Mann–Whitney U test and all statistical tests were two-sided. Results In the carotid body tumor group, the mean age was 55 years, females were more frequently affected 19 (83%). Shamblin I was identified in 9% of patients, Shamblin II in 52% and Shamblin III in 39%. Carotid body tumor laterality were 57% right, 34% left and 9% bilateral tumors. The eight domains that comprise the SF-36 questionnaire were statistically significant when compared to the control group. Conclusion Significant differences were found in all SF-36 domains in carotid body tumor patients in comparison to control subjects, confirming that this neoplasm has negative impact in the general HRQoL.

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Surgical Management of Bilateral Carotid Body Tumors

Cited by 42 publications

References 25 publications

Simple and complex carotid paragangliomas. Three decades of experience and literature review

Simple and complex carotid paragangliomas. Three decades of experience and literature review

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

Assessment of health-related quality of life in patients prior to carotid body tumor resection

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