Update in the classification and the role of intra‐arterial stenting in the management of carotid body paragangliomas

Abstract

Background To review the Shamblin classification of carotid body paragangliomas (CBPs) and the role of intra‐arterial stenting in their surgical management. Methods Retrospective case series of 20 patients with 28 CBPs that were surgically resected at our center. Intra‐arterial stenting was performed in Shamblin II and II classes. Results The mean follow‐up was 47.8 months. Five (17.9%) tumors were Shamblin class I, 15 (53.6%) were class II, and 8 (28.6%) were class III. Thirteen (68.4%) CBPs were associated with other paragangliomas. The internal carotid artery (ICA) was stented preoperatively in eight (28.6%) cases and occluded in four (14.3%) cases. The tumor extended to the jugular foramen in six cases (21.4%). Intraoperatively, there was an ICA injury in one case of Shamblin II CBP in the present era. Conclusions The proposed classification enables the clinician to plan the management of the ICA and the right approach. Stenting of the ICA gives a chance for complete tumor removal with arterial preservation.

Epigenomic dysregulation-mediated alterations of key biological pathways and tumor immune evasion are hallmarks of gingivo-buccal oral cancer

“…We have previously identified a set of driver genes for OSCC-GB, with significantly enhanced burden of somatic mutations and copy number alterations, some of which are unique compared to drivers of other subtypes of head and neck cancers [9, 10]. Unique findings in OSCC-GB have also been reported by transcriptome-wide studies [11, 12]. OSCC-GB, therefore, deserves to be investigated separately.…”

Long-Term Surgical Outcomes of Carotid Body Tumors With Pathological Fibrosis: A Cohort Study

“…In this study, significantly more patients required ICA reconstruction in the FCBTs than in the CCBTs, and more strokes occurred in the FCBTs than in the CCBTs although with no statistical significance (1.89% vs. 0.55%, p=0.35), which implied that pathological fibrosis might contribute to postoperative stroke after CBT resection. Sanna M et al found that stenting of the ICA facilitates complete tumor removal with arterial preservation (17). Therefore, pre-operative stenting of the ICA may be useful to avoid strokes in patients with Shamblin III or fibrous CBT.…”

“…Sanna M et al. found that stenting of the ICA facilitates complete tumor removal with arterial preservation ( 17 ). Therefore, pre-operative stenting of the ICA may be useful to avoid strokes in patients with Shamblin III or fibrous CBT.…”

“…Prudent preoperative planning, particularly in patients with prominent pathological fibrosis or Shamblin class II and III CBTs, may avoid inadvertent ICA manipulation and bleeding. Pre-operative ECA embolization or ICA/CCA coverage with stent grafts have been proposed to reduce bleeding ( 17 , 21 ). We preferred early ECA division during the operation in patients with prominent fibrosis or class II and III tumors, which was more effective than preoperative percutaneous embolization for reducing stroke rate ( 14 ).…”

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

“…Recently, the same group has reported eight patients with CPG, in six of whom the tumor extended to the base of the skull; stent placement offered the possibility of complete tumor excision with arterial preservation, and yielded excellent results (mean follow-up of 47.8 months). 20 We have successfully used this technical resource in one case of radical surgery for a non-CPG cervical tumor that encompassed the internal carotid artery. 21…”