Differential Diagnosis and Treatment Outcomes of Tumors at the Carotid Bifurcation

Abstract

Purpose Primary tumor at the carotid bifurcation is uncommon, which includes paraganglioma, schwannoma, and lymphoma. Due to their rarity, characteristics of these tumors and problems related to their surgical treatment have not been well known. We tried to elucidate different clinical characteristics and surgical complications of these tumors. Materials and Methods We retrospectively reviewed 21 patients with carotid bifurcation tumor from the Vascular Surgery division of a Korean tertiary institution from 1995 to 2018. We investigated patients’ demographics and clinical features, image characteristics, treatment details, and surgical outcomes. Results During the period from January 1995 to January 2018, we experienced surgical resections of 21 carotid bifurcation tumors which included 16 (76.2%) paragangliomas and 5 (23.8%) schwannomas. The most common clinical feature was a non-tender cervical mass. According to Shamblin classification, paragangliomas were classified into class II in 68.8% and class III in 25.0%. On the preoperative computed tomography images, all the paragangliomas showed characteristic splaying of the carotid bifurcation and hypervascularity of the tumors. On the contrary, all the schwannomas showed hypovascularity and splaying sign in 60%. Surgical complications related to cervical nerve injury developed in 50% and 60% of patients with Shamblin class III paraganglioma and schwannoma, respectively. During the mean follow-up period of 25 months (range, 1 to 163 months), distant metastases developed in 2 (12.5%) of paraganglioma patients. Conclusion Neurologic complications were more common after surgical resection of Shamblin class III paraganglioma and schwannoma. For patients with paraganglioma, postoperative periodic follow-up examination is advised to detect distant metastasis.

Malignant carotid body tumors: What we know, what we do, and what we need to achieve. A systematic review of the literature

“…Among these articles, 20 (158 patients) included 5 or more patients (Table 1) 18–39 and were considered for the proportion MA. The remaining 112 studies (179 patients), represented by case reports or case series with <5 patients, are reported in Table S1 3,40–152 …”

“…For proportion meta‐analysis (MA), only case series with at least five consecutive cases were considered (Table 1). 18–39 All the other case series describing less than five patients (including case reports) were considered only for the SR and detailed in Table S1 3,40–152 …”

Clinical outcomes and challenges of surgical extirpation for carotid body paraganglioma in South Korea: a single-center retrospective study

“…Although active surveillance is reportedly a superior option for CBP management [ 11 , 12 ], complete surgical resection is believed as a primary treatment of choice when it is available [ 1 , 6 , 13 ]. When considering surgical removal of CBP, we worry about two things; intraoperative bleeding and CNP.…”

“…We previously described carotid body paraganglioma (CBP) characteristics different from cervical schwannoma [ 1 ]. In 2017, the World Health Organization (WHO) published guidelines regarding adrenal and extra-adrenal paraganglioma [ 2 ].…”