Ectopic parathyroid adenoma adherent to vagus nerve at internal carotid artery

Ng, Jimmy; Roche, Phoebe; Weir, Justin; Mace, Alasdair

doi:10.1016/j.xocr.2020.100197

Cited by 2 publications

(6 citation statements)

References 20 publications

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“…Gland Surg 2023 | https://dx.doi.org/10.21037/gs-22-589 nerve 3 cm above the carotid bifurcation and subsequently used a careful "nerve-sparing approach" with lymph node excision to resect the lesion (13). The adenoma in the present case was visually confirmed to be independent from the vagus nerve and therefore no dissection of ectopic tissue from the nerve was needed.…”

Section: Discussionmentioning

confidence: 76%

“…Though carotid sheath involvement is rare (11,12), identification and resection of parathyroid adenomas within the sheath has been demonstrated to be especially difficult. Groups have previously described cases in which failed primary surgery for hyperparathyroidism has been attributed to adenomas later localized to the carotid sheath (13)(14)(15)17). Ojha et al described identification of a carotid sheath parathyroid adenoma between the carotid artery and jugular vein via Tc-99m Sestamibi after failed primary resection (17).…”

Section: Discussionmentioning

confidence: 99%

“…In two large reports, which together examined nearly 1,200 parathyroid surgeries performed for primary hyperparathyroidism, only two cases had adenomas involving the carotid sheath (11,12). Despite its rare presentation, there have been multiple cases in which failed primary parathyroid resection has been attributed to ectopic tissue later localized to the carotid sheath (13,14). One of these cases demonstrated an intravagal parathyroid adenoma within the carotid sheath which necessitated careful dissection from the nerve (13).…”

Section: Introductionmentioning

confidence: 99%

“…Despite its rare presentation, there have been multiple cases in which failed primary parathyroid resection has been attributed to ectopic tissue later localized to the carotid sheath ( 13 , 14 ). One of these cases demonstrated an intravagal parathyroid adenoma within the carotid sheath which necessitated careful dissection from the nerve ( 13 ). These cases demonstrate the potential need for intra-operative adjuncts like ICG fluorescence in resection of this unique variant.…”

Section: Introductionmentioning

confidence: 99%

“…These cases demonstrate the potential need for intra-operative adjuncts like ICG fluorescence in resection of this unique variant. Although groups have described resection of adenomas within the carotid sheath ( 13 , 15 ) previously, use of intraoperative ICG fluorescence imaging has not been demonstrated in these cases. The case below demonstrates the use of ICG fluorescence to guide resection of an ectopic parathyroid gland adenoma located within the left posterior carotid sheath.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Indocyanine green fluorescence guided resection of parathyroid adenoma of the carotid sheath: a case report and review of the literature

Rupp¹,

Barba²,

Goldhaber³

et al. 2023

Gland Surg

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Background: Ectopic parathyroid tissue can pose difficulties in diagnosis, management, and resection of adenomas in patients with hyperparathyroidism. The use of multimodal pre-operative imaging is recommended due to the diverse anatomic presentation of parathyroid adenomas and the potential presence of multiple adenomas. Resection failure still can occur, however, indocyanine green (ICG) fluorescence imaging is an intraoperative tool that has potential to help address this challenge. In the case which follows we demonstrate the use of ICG fluorescence imaging to assist in successful resection of a parathyroid adenoma located within the carotid sheath.Case Description: We present the case of a 75-year-old woman with primary hyperparathyroidism due to a parathyroid adenoma localized to the left carotid sheath, posterior to the carotid artery. Careful resection was aided by ICG fluorescence guidance allowing for complete resection and immediate postoperative restoration of normal Parathyroid Hormone and calcium levels. The patient had no peri-operative complications and had an unremarkable post-operative course. Conclusions:The anatomical heterogeneity of parathyroid gland adenomas within and around the carotid sheath presents a unique diagnostic and surgical scenario; however, the use of intra-operative ICG, as presented in this case, has important implications for endocrine surgeons and surgical trainees alike. This tool provides improved intra-operative identification of the parathyroid tissue allowing for safe resection, especially in cases involving critical anatomical structures.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Indocyanine green fluorescence guided resection of parathyroid adenoma of the carotid sheath: a case report and review of the literature

Rupp¹,

Barba²,

Goldhaber³

et al. 2023

Gland Surg

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Parathyroid Imaging: Past, Present, and Future

et al. 2022

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The goal of parathyroid imaging is to identify all sources of excess parathyroid hormone secretion pre-operatively. A variety of imaging approaches have been evaluated and utilized over the years for this purpose. Ultrasound relies solely on structural features and is without radiation, however is limited to superficial evaluation. 4DCT and 4DMRI provide enhancement characteristics in addition to structural features and dynamic enhancement has been investigated as a way to better distinguish parathyroid from adjacent structures. It is important to recognize that 4DCT provides valuable information however results in much higher radiation dose to the thyroid gland than the other available examinations, and therefore the optimal number of phases is an area of controversy. Single-photon scintigraphy with 99mTc-Sestamibi, or dual tracer 99mTc-pertechnetate and 99mTc-sestamibi with or without SPECT or SPECT/CT is part of the standard of care in many centers with availability and expertise in nuclear medicine. This molecular imaging approach detects cellular physiology such as mitochondria content found in parathyroid adenomas. Combining structural imaging such as CT or MRI with molecular imaging in a hybrid approach allows the ability to obtain robust structural and functional information in one examination. Hybrid PET/CT is widely available and provides improved imaging and quantification over SPECT or SPECT/CT. Emerging PET imaging techniques, such as 18F-Fluorocholine, have the exciting potential to reinvent parathyroid imaging. PET/MRI may be particularly well suited to parathyroid imaging, where available, because of the ability to perform dynamic contrast-enhanced imaging and co-registered 18F-Fluorocholine PET imaging simultaneously with low radiation dose to the thyroid. A targeted agent specific for a parathyroid tissue biomarker remains to be identified.

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Ectopic parathyroid adenoma adherent to vagus nerve at internal carotid artery

Cited by 2 publications

References 20 publications

Indocyanine green fluorescence guided resection of parathyroid adenoma of the carotid sheath: a case report and review of the literature

Indocyanine green fluorescence guided resection of parathyroid adenoma of the carotid sheath: a case report and review of the literature

Parathyroid Imaging: Past, Present, and Future

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