Coil Embolization and Surgical Removal of Carotid Body Paraganglioma

Abstract

Carotid body paraganglioma has considerable malignant potential and locally aggressive behavior, so it should be treated as soon as it is discovered.We report the case of 60-year-old male patient with a carotid body paraganglioma (Shamblin group II) that was causing the carotid arteries to spread. Angiography showed 1 dominant feeding artery arising from the right external carotid artery. Selective angiography was performed 2 days before surgical removal of the tumor, and the feeding artery was successfully embolized with coils.Literature review reveals previous reports where preoperative embolization of the feeding arteries was done using ethanol, polymers, or other liquid agents. In our case, angiography (via femoral artery) was performed 2 days before surgical removal of the tumor, and the main feeding artery (a single branch arising from external carotid artery) was successfully embolized with coils rather than liquids.Performing coil embolization before operating reduced subsequent blood loss and made it easier to identify the feeding artery during surgery. Supraselective coiling, although as difficult as embolization with liquids, may reduce the incidence of postoperative stroke. At 1 year after surgery, the patient had no signs of tumor recurrence.

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

“…The main described advantage of preoperative embolization with microcoils is the ability of palpatory detection of them during surgery and the absence of risks of distal embolism [7]. The disadvantages include the high cost of microcoils [28]. In our opinion, microcoils alone (without NAGLEMs) cannot be used for embolization due to the preservation of blood flow through smaller afferents and microcirculatory network, which was well demonstrated by the AVM of the face group and in case #2.…”

A Hybrid Approach Towards Successful Resection of a Huge Carotid Body Paraganglioma Using Coil Embolization and Traditional Surgical Techniques

“…Previous studies have reported various benefits of embolization such as reduction in tumor size, intra-operative blood loss, operative time, reduced complications and hospital stay [11][12][13]. The unique advantage of Microcoil embolization as we have experienced, is the ability to deploy the coil selectively, precisely and proximal to the feeding vessel thereby preventing complications of unwarranted distal embolization [13,14]. Intraoperatively an added advantage is the ability to palpate the coil and it acts as a surgical marker in identifying the feeding vessels [14].…”

“…The unique advantage of Microcoil embolization as we have experienced, is the ability to deploy the coil selectively, precisely and proximal to the feeding vessel thereby preventing complications of unwarranted distal embolization [13,14]. Intraoperatively an added advantage is the ability to palpate the coil and it acts as a surgical marker in identifying the feeding vessels [14]. A recent advancement in the endovascular approach to CBPGLs is the use of covered stents for vascular exclusion and studies have shown promising results.…”

Adjunct endovascular interventions in carotid body tumors

“…Unfortunately, the Shamblin classification has been adopted in only 19 of 60 (32%) of the eligible studies, 11,17,21,23,[25][26][27][28][30][31][32][33][34][35][36][37][38][39] and therefore, the benefit of preoperative embolization in CBTs of the highest size grade has yet to be demonstrated. The size of tumors treated with preoperative embolization and surgical excision was 1.6 to 11 cm, almost the same (range, 2-12 cm) in the patients treated with surgery only (Table IV).…”