Surgical treatment of paragangliomas of the carotid bifurcation: Results of 36 patients

Köhler, Hugo Fontan; Carvalho, André L.; Granja, Nara Valeria Mattos; Nishinari, Kenji; Kowalski, Luiz Paulo

doi:10.1002/hed.20105

Cited by 28 publications

(24 citation statements)

References 21 publications

(20 reference statements)

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“…A particular complication in CBT surgery is blood pressure instability (as the carotid body physiologically functions as a baroreceptor): both hypotension (Kohler et al 2004) and, with bilateral resection, severe resistant hypertension (baroreceptor failure syndrome) can occur (De Toma et al 2000). Chemoreflex dysfunction (absence of a normocapnic hypoxic ventilatory response) is almost universal, but baroreflex dysfunction occurs inconstantly (Timmers et al 2003).…”

Section: Carotid Body Tumoursmentioning

confidence: 99%

The management of head-and-neck paragangliomas

Căpățînă

Ntali

Karavitaki

et al. 2013

Endocrine-Related Cancer

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Paragangliomas (PGLs) are tumours originating from neural crest-derived cells situated in the region of the autonomic nervous system ganglia. Head-and-neck PGLs (HNPGLs) originate from the sympathetic and parasympathetic paraganglia, most frequently from the carotid bodies and jugular, tympanic and vagal paraganglia, and are usually non-catecholamine secreting. Familial PGLs are considered to be rare, but recently genetic syndromes including multiple PGLs and/or phaeochromocytomas have been more thoroughly characterised. Nowadays, genetic screening for the genes frequently implicated in both familial and sporadic cases is routinely being recommended. HNPGLs are mostly benign, generally slow-growing tumours. Continuous growth leads to the involvement of adjacent neurovascular structures with increased morbidity rates and treatment-related complications. Optimal management mostly depends on tumour location, local involvement of neurovascular structures, estimated malignancy risk, patient age and general health. Surgery is the only treatment option offering the chance of cure but with significant morbidity rates, so a more conservative approach is usually considered, especially in the more difficult cases. Radiotherapy (fractionated or stereotactic radiosurgery) leads to tumour growth arrest and symptomatic improvement in the short term in many cases, but the longterm consequences are unclear. Early detection is essential in order to increase the chance of cure with a lower morbidity rate. The constant improvement in diagnostic imaging, surgical and radiation techniques has led to a safer management of these tumours, but there are still many therapeutic challenges, and no treatment algorithm has been agreed upon until now. The management of HNPGLs requires a multidisciplinary effort addressing the genetic, surgical, radiotherapeutic, oncological, neurological and endocrinological implications. Further progress in the understanding of their pathogenesis will lead to more effective screening and earlier diagnosis, both critical to successful treatment.

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Section: Carotid Body Tumoursmentioning

confidence: 99%

The management of head-and-neck paragangliomas

Căpățînă

Ntali

Karavitaki

et al. 2013

Endocrine-Related Cancer

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“…The surgical excision with careful sub-adventitial dissection is the treatment of choice for most carotid body paragangliomas (Shamblin I and II). The Shamblin III type requires resection of the external and/or internal carotid artery [7]. In our case, the carotid body tumor was of Shamblin type I and was excised by transcervical approach.…”

Section: Discussionmentioning

confidence: 87%

“…Shamblin classification of carotid body tumors was used to predict the risk of internal carotid artery compromise [7]. The surgical excision with careful sub-adventitial dissection is the treatment of choice for most carotid body paragangliomas (Shamblin I and II).…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Parapharyngeal Space Tumors: Our Experience

Metgudmath

Malur

et al. 2012

Indian J Otolaryngol Head Neck Surg

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The purpose of this study is to evaluate parapharyngeal space (PPS) tumors with regards to clinicopathological features and pre-operative assessment and also to analyze the benefits of transcervical approach in the management of PPS tumors. We performed retrospective analysis of patients who had undergone transcervical resection of PPS tumors from May 2006 to May 2009 at KLES Dr. Prabhakar Kore Hospital and M. R. C, Belgaum. Patients were diagnosed on the basis of clinical examination, FNAC and magnetic resonance imaging. All patients were observed with an annual follow-up of at least 3 years by physical examination and ultrasonographic evaluation. The total number of patients were four; with three males and one female patient. Their age varied from 20 to 55 years with a mean age of 36 years. There were two cases of neurilemomas, one case of carotid body tumor and one case of pleomorphic adenoma. All four patients underwent surgical excision of tumor by transcervical approach. There were no major post-operative complications. All four patients are alive with no recurrence in the 3 year follow-up period. Transcervical approach is versatile, flexible and provides good access to the narrow PPS. This approach also provides good vascular control and reduced risk of post-op complications. We recommend transcervical approach even for large sized pre-styloid and post-styloid compartment benign tumors which are free from deep lobe of parotid.

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“…Although good results were achieved with complete surgical removal and total excision with microsurgical approach can often be accomplished, there is a significant risk of morbidity (0-39%) and mortality (0-2.7%) with this approach [7]- [9] . Radiotherapy is treatment of choice for patients with intracranial extension, and patients with bilateral and multiple tumors, or patients who are inoperable.…”

Section: Resultsmentioning

confidence: 99%