Effective, same‐day preoperative embolization and surgical resection of carotid body tumors

Katagiri, Kartsunori; Shiga, Kiyoto; Ikeda, Aya; Saito, Daisuke; Oikawa, Shinichi; Tshuchida, Kodai; Miyaguchi, Jun; Tamura, Akio; Nakasato, Tatsuhiko; Ehara, Shigeru; Ishida, Kazuyuki

doi:10.1002/hed.25805

Cited by 25 publications

(18 citation statements)

References 23 publications

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“…Therefore, their feeding arteries might also be freely introduced from the ECA during the embryonic phase. We propose this idea from our own study data (34)(35)(36). Shibao et al also focused on the embryonic origin of the feeding arteries of CBTs (37).…”

Section: Resultsmentioning

confidence: 92%

“…The development of angiographic techniques and imaging revealed that the multi-angle view of the results of angiography make finding multiple feeders of CBTs easier, especially by digital subtraction angiography and construction of the three-dimensional view of the image (32, 33) (Figure 2A). Multiple feeding arteries of a CBT can be recognized using these angiographic imaging techniques, and there have been surprising results obtained by these techniques (34)(35)(36) such as that shown in Figure 2. Most CBTs have multiple feeding arteries arising from the branches of the external carotid artery (ECA), such as the superior thyroid, ascending pharyngeal, facial, and occipital arteries.…”

Section: Resultsmentioning

confidence: 99%

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Challenges of Surgical Resection of Carotid Body Tumors - Multiple Feeding Arteries and Preoperative Embolization

et al. 2022

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Background: Carotid body tumor is a hypervascular tumor with multiple feeding arteries and unique orientation at the carotid bifurcation. Although resection is a radical therapy for this tumor, complete resection is challenging. Materials and Methods: Articles reporting carotid body tumor treatment and surgical resection were reviewed including case-control series and review articles. Results: Selected reports were reviewed and discussed focusing on choice of treatment, surgical difficulties and preoperative embolization of feeding arteries. Conclusion: Multiple feeding arteries and adhesion of the tumor to the carotid arterial wall are causes of difficulties in carotid body tumor resection. The effectiveness of preoperative embolization remains controversial due to the varied situations in performing surgical resection among the institutions. However, perfect embolization and resection immediately after embolization reduce blood loss and operative time of surgery for carotid body tumor.Carotid body tumor (CBT) is a rare disease that originates from the paraganglion cells (paraganglioma) of the carotid body at the carotid bifurcation. The World Health Organization classification designated this tumor as malignant because it has a malignant potency and there is no requirement to distinguish benign from malignant features in the pathological findings of specimens (1).It is well-known that malignant tumors cannot always be identified by their morphological features in histopathological examinations; clinical findings such as metastatic activity can distinguish malignant tumors from their benign counterparts. Only clinical findings, such as lung, liver, or bone metastasis, indicate that a tumor is malignant. The slow-growing feature of CBT represents an almost benign character and embryonic origin plus germline mutation of this tumor. Its potential for metastatic activity highlights the need for surgical resection. Surgical resection of CBT by head and neck surgeons must be considered once a patient is referred to a hospital. However, in contrast to the slow-growing feature of this tumor, characteristic features, such as a rich vascular network of its capsule supplied by many feeding arteries, complicate resection (2).In recent years, it has been revealed by molecular biological studies that various types of gene alterations exist in the succinate dehydrogenase (SDH) gene family such as point mutations (3-5). Most patients with CBT were shown to have variants with germline mutations, such as SDHB and SDHD. Conversely, the idea of "hereditary paragangliomapheochromocytoma syndrome" has been frequently used to explain patients with familial paraganglioma, and it extends to patients with CBT who have a family history of the disease and gene alterations (6-8). Therefore, analyses of gene alterations are needed for patients with CBT. In addition, systemic diagnosis is needed to identify other types of paraganglioma, such as pheochromocytoma, since patients with SDH variants tend to have multiple paragangliomas (9).The Sha...

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Section: Resultsmentioning

confidence: 92%

Section: Resultsmentioning

confidence: 99%

Challenges of Surgical Resection of Carotid Body Tumors - Multiple Feeding Arteries and Preoperative Embolization

et al. 2022

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“…We developed a novel method of CBT surgery, entitled “same-day operation” which consisted of embolization of the feeding arteries in the morning and resection of CBT in the afternoon of the same day. This procedure markedly reduces the blood loss and operative time of CBT surgery [ 13 ]. However, some patients required carotid artery resection and reconstruction, owing to firm the attachment or invasion of the carotid artery wall by the tumor, resulting in increased blood loss and operation time.…”

Section: Discussionmentioning

confidence: 99%

“…General anesthesia was administered during the surgery. The surgical procedure has been described previously [ 13 ]. Briefly, after dissection of the common carotid artery (CCA), the carotid bifurcation was visible.…”

Section: Methodsmentioning

confidence: 99%

The Influence of Young Age on Difficulties in the Surgical Resection of Carotid Body Tumors

Katagiri

Shiga

Ikeda

et al. 2021

Cancers

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This study evaluated patient characteristics that affect the complexity and difficulties of performing surgery to resect carotid body tumors (CBTs). We retrospectively reviewed the medical records of 20 patients with 21 CBTs who were enrolled in the study. The median patient age was 46 years and the mean tumor diameter was 37.6 mm. The mean blood loss and operative time were 40.3 mL and 183 min, respectively. Four patients underwent resection of the carotid artery followed by reconstruction. These four patients were between 18 to 23 years of age at the time of surgery. The mean blood loss and operative time in these patients were 166 mL and 394 min, respectively, which differed significantly from those of older patients. Therefore, young age influenced the difficulties faced in surgical resection of CBT, with an increased risk of blood loss and carotid artery resection.

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“…[15][16][17] Nevertheless, other specialists suggest that ECA embolization prior to surgery can reduce intraoperative blood loss volume. [18][19][20] Moreover, a recent metaanalysis enrolling 1326 patients suggested that patients who received preoperative embolization had lower intraoperative blood loss volumes and shorter operation duration. 21 However, an interesting study showed that preoperative CBT embolization (0 to 3 days prior to surgery) was associated with an increased unadjusted blood loss rate compared with the nonembolization group, but without statistical significance.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and outcomes of surgical treatment of carotid bifurcation tumors

Zhang

Shu

et al. 2020

J Int Med Res

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Objective To retrospectively review our experience with the diagnosis and treatment of carotid bifurcation tumors (CBFT). Methods This was a retrospective study of 60 patients with CBFT who underwent surgical and conservative treatment. The patients’ clinicopathological features, imaging examination findings, treatment strategy, and prognosis were analyzed. The surgical grade, blood loss, tumor size, operative time, and postoperative complications were analyzed by Spearman’s correlation. Results Resection was performed in 52 patients with 53 tumors. The mean tumor volume, operative time, estimated blood loss, and follow-up time was 47.62 ± 65.28 cm3, 176.1 ± 86.55 minutes, 231.3 ± 354.0 mL, and 44.42 ± 29.30 months, respectively. Pathological examination showed that the number of carotid body tumors (CBT; paraganglioma), neurilemmoma, mesenchymal tissue tumor, and angioleiomyoma was 42, 8, 1, and 1, respectively. Of the CBT group, the rate of Shamblin Type I, II, and III was 11.9%, 59.5%, and 28.6%, and three cases were malignant CBT with lymph node metastasis. Spearman’s correlation analysis showed that complication grade was significantly related to surgical difficulty grade and operative time. Conclusion CBT is the most frequent lesion in CBFT, and CBT may be treated safely by surgical management. The severity of surgical complications is significantly correlated with surgical difficulty.

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Effective, same‐day preoperative embolization and surgical resection of carotid body tumors

Cited by 25 publications

References 23 publications

Challenges of Surgical Resection of Carotid Body Tumors - Multiple Feeding Arteries and Preoperative Embolization

Challenges of Surgical Resection of Carotid Body Tumors - Multiple Feeding Arteries and Preoperative Embolization

The Influence of Young Age on Difficulties in the Surgical Resection of Carotid Body Tumors

Diagnosis and outcomes of surgical treatment of carotid bifurcation tumors

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