Beneficial effects of preoperative superselective embolization on carotid body tumor surgery: A 13-year single-center experience

Abstract

PurposeThis study presented our 13-year experience managing patients with CBTs (carotid body tumors) and was aimed to investigate the impact of pre-TAE (preoperative transarterial embolization) on CBT surgical resection.MethodsThis retrospective study reviewed 169 surgically excised CBTs between May 2007 and October 2020. According to whether to carry out the pre-TAE, the patients were classified into the embolization (EG) (n = 130) and non-embolization groups (NEG) (n = 39). Tumor classification was based on Shamblin criteria and tumor size. The demographic data, clinical features, and intraoperative and postoperative information about the patients were retrieved and analyzed.ResultsThe average tumor size was (43.49 vs. 35.44 mm, p = 0.04) for EG and NEG. The mean surgical time (195.48 vs. 205.64 mins, p = 0.62) and intraoperative BL (blood loss) (215.15 vs. 251.41 cc, p = 0.59) were less, but the incidence of revascularization required (29% vs. 33%, p = 0.62) and total complications (26% vs. 36%, p = 0.32) were lower in EG compared to NEG. Similarly, according to the subgroup analysis, no significant differences were detected in the surgical time, BL, adverse events (AEs), and the revascularization in EG when compared to NEG for type I (n = 5 vs. 7), II (n = 105 vs. 27), and III (n = 20 vs. 5), respectively except for the surgical duration in type III (p < 0.05). However, a significantly lower incidence of AEs (230.25 vs. 350 cc, p = 0.038) and a decline in BL (28.57% vs. 48.15%, p = 0.049) in EG were observed compared to those in NEG patients for large CBTs (≥ 30 mm as the cutoff point). No surgery-related mortality was observed during the follow-up.ConclusionsCBTs can be surgically resected safely and effectively with a need for pre-TAE, which significantly decreases the overall BL and AEs for large lesions (≥ 30 mm).

Safe management of carotid body tumor resection without preoperative embolization: an Ecuadorian high-altitude cities experience

“…A study from Cochabamba, Bolivia (2600 mas) reported 30 patients with a female predominance (24/30), with a mean tumor size of 3.5 cm and just two patients underwent pre-TAE [ 4 ]. Also, a recent study located in Tibet Plateau in China (3000 mas) showed 122 CBT without pre-TAE and with a maximal diameter of tumors of 3.99 cm [ 5 ]. It has been postulated that the monthly loss of blood through menstruation in women and a larger pulmonary capacity and greater enthusiasm for sports and athletic conditioning in men may allow males to escape chronic hypoxia and account for this wide gender gap [ 9 ].…”

“…In addition, the CBTs were mainly classified as Shamblin II and III. A recent Chinese study reported a ratio of ∼1:1.7:1 in Shamblin type I, II and III, respectively [ 5 ].…”

“…La Paz, Bolivia, a city 3625 m above the sea (mas) has reported a high frequency of CBTs in its population [ 4 ]. Another example that supports this hypothesis is the Tibet Plateau in China with a mean altitude of more than 3000 m [ 5 ].…”

The Advantages of Non-Adhesive Gel-like Embolic Materials in the Endovascular Treatment of Benign Hypervascularized Lesions of the Head and Neck

“…Minimally invasive procedures are becoming increasingly popular in the management of benign hypervascularized masses located in the head and neck regions [1][2][3][4][5]. Embolization is a method of blocking the blood supply to these masses, and can be implemented for preparation before open surgical removal [5][6][7], to decrease blood supply prior to radiosurgery [8], or as a standalone treatment option [9].…”

“…Various embolic agents have been proposed to occlude the vascular bed of hypervascularized benign head and neck masses (PVA [6], microspheres [6], microcoils [6], gelatin sponge [6], absolute ethanol [9], ONYX [4]). These embolic agents differ not only in their physical and chemical properties, but also in their intended applications and techniques of delivery into the vascular bed.…”