Die präoperative angiographische Embolisation von Tumoren des Karotisglomus

Abstract

During surgical resections carotid body tumors may bleed profusely due to their vascularity. Preoperative angiographic embolization of tumor-supplying arteries has reduced intraoperative blood loss significantly. The present study reviews our clinical experiences with 13 paragangliomas of the carotid bifurcation in 12 patients during the past 5 years. In 6 patients (46.1%) computed tomography and magnetic resonance imaging demonstrated extensive spread of the tumor up to the base of the skull. Tumors of this size were initially assessed as being inoperable but curative surgical resections were performed after embolization of tumor-supplying arteries by intravascular injections of Gelfoam and implantations of microcoils. Vascular reconstruction of the internal carotid artery by a saphenous vein graft was required in 4 patients (30.7%). In 3 malignant paragangliomas (23.0%) adjuvant radiotherapy of 50-60 Gy was administered to the tumor site after surgery. During an average follow-up of 29 months, one malignant paraganglioma was found to have recurred locally 13 months after initial therapy.

Paragangliomas and paraganglioma syndromes

“…The management of HNPs remains controversial [1], [3], [4], [37], [48], [85], [86], [87]. The current treatment options include surgical resection [1], [2], [3], [19], [48], [59], [88], [89], conventional radiation therapy [47], [90], [91], [92], stereotactic radiosurgery (for jugulotympanic PGs only) [85], [86], [93], permanent embolisation [20], [37] and a combination of those modalities.…”

“…Therapeutic options for the treatment of cervical HNPs include complete surgical resection [1], [2], [3], [4], [19], [48], [88], [95], conventional radiotherapy [47], [90], [91], [92] and permanent embolisation [20], [37]. Due to generally slow tumor growth, a “wait and scan” policy might be justified in certain cases [1], [2], [3], [45].…”

“…The first successful resection of a CBT dates back to 1889 (cited in [36]). Before the development of vascular surgical reconstructive techniques in the 1960s and 1970s the results of sugical resection were miserable [37]. Mortality rates of 5-30 % have been reported in those days (cited in [37]).…”

“…Before the development of vascular surgical reconstructive techniques in the 1960s and 1970s the results of sugical resection were miserable [37]. Mortality rates of 5-30 % have been reported in those days (cited in [37]). Today, complete surgical resection of cervical HNPs is considered the treatment of choice for the vast majority of patients by most authors around the world [1], [2], [3], [4], [19], [48], [56], [88], [89], [95], [96], [97], [98].…”

“…Via the glossopharyngeal nerve they are directly connected to the respiratory centers in the central nervous system. Carotid body paraganglia are involved in regulation of respiration and blood pH value, blood pressure and heart rate [36], [37], [38], [39]. The function of the other head and neck paraganglia remains less clear [40].…”